Usui Kojiro, Kitazaki Yuki, Enomoto Soichi, Morita Mihoko, Nakamichi Kazuo, Hamano Tadanori
Department of Neurology, University of Fukui Hospital.
Department of Hematology and Oncology, University of Fukui Hospital.
Rinsho Shinkeigaku. 2023 Aug 29;63(8):513-517. doi: 10.5692/clinicalneurol.cn-001847. Epub 2023 Jul 29.
An 83-year-old man presented with visual disturbance and right hemiparalysis, one month after daratumumab, bortezomib, and dexamethasone administration for multiple myeloma (MM). Blood screens revealed a CD4+ T-lymphocyte count of 132/μl. Diffusion weighted and fluid-attenuated inversion-recovery MR imaging showed high intensity signals in the both occipital lobes and left precentral area. The patient had no history of human immunodeficiency virus infection. Cerebrospinal fluid (CSF) JC virus (JCV) was positive (83 copies/ml), as indicated by PCR. The patient was diagnosed with progressive multifocal leukoencephalopathy (PML). MM treatment was discontinued, and mefloquine and mirtazapine therapy was started. However, the CSF JCV-DNA PCR count did not improve (111 copies/ml) after 30 days from starting mefloquine and mirtazapine therapy. The patient died six months after symptom onset. Conclusively, patients with decreased CD4+ T lymphocyte counts following DBd therapy for MM, the possibility of PML should be considered.
一名83岁男性在接受达雷妥尤单抗、硼替佐米和地塞米松治疗多发性骨髓瘤（MM）1个月后，出现视力障碍和右侧偏瘫。血液检查显示CD4+T淋巴细胞计数为132/μl。弥散加权成像和液体衰减反转恢复磁共振成像显示双侧枕叶和左侧中央前区有高强度信号。该患者无人类免疫缺陷病毒感染史。脑脊液（CSF）JC病毒（JCV）经聚合酶链反应检测呈阳性（83拷贝/ml）。该患者被诊断为进行性多灶性白质脑病（PML）。MM治疗中断，开始使用甲氟喹和米氮平治疗。然而，在开始甲氟喹和米氮平治疗30天后，脑脊液JCV-DNA聚合酶链反应计数并未改善（111拷贝/ml）。患者在症状出现6个月后死亡。总之，MM患者在接受DBd治疗后CD4+T淋巴细胞计数降低，应考虑发生PML的可能性。
