Ohno Masasuke, Kuramitsu Shunichiro, Iwakoshi Akari, Yamaguchi Junya, Ohka Fumiharu, Saito Ryuta
1Department of Neurosurgery, Aichi Cancer Center, Nagoya, Japan.
Departments of2Neurosurgery and.
J Neurosurg Case Lessons. 2022 Aug 8;4(6). doi: 10.3171/CASE22256.
Although the risk of developing malignant lymphoma is higher in patients with rheumatoid arthritis (RA) than in the general population, primary central nervous system lymphoma (PCNSL) in patients with RA is extremely rare. In recent years, there has been concern that biological disease-modifying antirheumatic drugs (bDMARDs), widely administered to patients with RA, might increase the risk of cancer development. The authors report the first case of PCNSL in a patient with RA receiving the bDMARD tocilizumab.
A 70-year-old man who was diagnosed with RA in 2010 was treated with low-dose methotrexate (MTX) from 2010 to 2015. Tocilizumab was commenced in 2012. In 2018, he developed gait disturbances, and gadolinium-enhanced magnetic resonance imaging showed multiple contrast-enhanced lesions in the basal ganglia and brain stem. Stereotactic brain biopsy led to the diagnosis of diffuse large B-cell lymphoma, and finally PCNSL was diagnosed. He was treated with five courses of MTX 3.5 g/m2, and his disease has been in remission for 34 months.
Low-dose MTX and bDMARDs are associated with the concern of increased cancer risk in patients with RA. Because tocilizumab has been in use for a relatively short time, further accumulation of cases and careful follow-up are necessary.
尽管类风湿关节炎（RA）患者发生恶性淋巴瘤的风险高于普通人群，但RA患者的原发性中枢神经系统淋巴瘤（PCNSL）极为罕见。近年来，人们担心广泛应用于RA患者的生物性抗风湿药物（bDMARDs）可能会增加癌症发生风险。作者报告了首例接受bDMARD托珠单抗治疗的RA患者发生PCNSL的病例。
一名2010年被诊断为RA的70岁男性，在2010年至2015年期间接受低剂量甲氨蝶呤（MTX）治疗。托珠单抗于2012年开始使用。2018年，他出现步态障碍，钆增强磁共振成像显示基底节和脑干有多个强化病灶。立体定向脑活检诊断为弥漫性大B细胞淋巴瘤，最终确诊为PCNSL。他接受了5个疗程的3.5 g/m² MTX治疗，目前病情已缓解34个月。
低剂量MTX和bDMARDs与RA患者癌症风险增加的担忧有关。由于托珠单抗的使用时间相对较短，需要进一步积累病例并进行仔细随访。
