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静脉注射利妥昔单抗治疗造血干细胞移植后疱疹后相关性 EBV 再激活致急性横贯性脊髓炎一例

Successful Treatment of Epstein-Barr Virus Reactivation-associated Transverse Myelitis Following Herpes Zoster with Intravenous Rituximab in a Cord Blood Transplant Recipient.

机构信息

Department of Hematology, Nagano Red Cross Hospital, Japan.

Department of Neurology, Nagano Red Cross Hospital, Japan.

出版信息

Intern Med. 2024 Sep 1;63(17):2445-2450. doi: 10.2169/internalmedicine.2874-23. Epub 2024 Feb 1.

DOI:10.2169/internalmedicine.2874-23
PMID:38296479
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11442935/
Abstract

The Epstein-Barr virus (EBV) is associated with many malignancies and autoimmune diseases, including multiple sclerosis. In addition, EBV rarely but occasionally causes central nervous system (CNS) complications. We herein report a case of transverse myelitis (TM) associated with systemic EBV reactivation after herpes zoster infection in a cord blood transplant recipient. Identification of EBV-infected peripheral blood cells revealed a predominance of B cells. Notably, intravenous rituximab ameliorated EBV reactivation and TM. Since the CNS infiltration rate of intravenous rituximab is markedly low, the clinical efficacy of rituximab against TM suggests that EBV reactivation may cause TM via immune-mediated mechanisms.

摘要

爱泼斯坦-巴尔病毒（EBV）与许多恶性肿瘤和自身免疫性疾病有关，包括多发性硬化症。此外，EBV 很少但偶尔会导致中枢神经系统（CNS）并发症。我们在此报告一例在接受脐血移植的患者中，带状疱疹感染后全身 EBV 再激活引起的横贯性脊髓炎（TM）。鉴定 EBV 感染的外周血细胞显示 B 细胞占优势。值得注意的是，静脉注射利妥昔单抗改善了 EBV 再激活和 TM。由于静脉注射利妥昔单抗对中枢神经系统的渗透率明显较低，利妥昔单抗治疗 TM 的临床疗效表明 EBV 再激活可能通过免疫介导的机制引起 TM。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3b3f/11442935/3b1034f30b33/1349-7235-63-2445-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3b3f/11442935/463d630af510/1349-7235-63-2445-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3b3f/11442935/d517ece03c6c/1349-7235-63-2445-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3b3f/11442935/3b1034f30b33/1349-7235-63-2445-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3b3f/11442935/463d630af510/1349-7235-63-2445-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3b3f/11442935/d517ece03c6c/1349-7235-63-2445-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3b3f/11442935/3b1034f30b33/1349-7235-63-2445-g003.jpg

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本文引用的文献

1
Epstein-Barr virus-associated acute disseminated encephalomyelitis successfully treated with rituximab: a case report.利妥昔单抗成功治疗爱泼斯坦-巴尔病毒相关急性播散性脑脊髓炎：一例报告
Encephalitis. 2021 Jul;1(3):85-88. doi: 10.47936/encephalitis.2021.00066. Epub 2021 Jun 7.
2
Successful treatment with rituximab for central nervous system vasculitis caused by Epstein-Barr virus-associated lymphoproliferative disorder with immunoglobulin M gammopathy.利妥昔单抗成功治疗由爱泼斯坦-巴尔病毒相关淋巴增殖性疾病伴免疫球蛋白M型丙种球蛋白病引起的中枢神经系统血管炎。
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Epstein-Barr virus and multiple sclerosis.
爱泼斯坦-巴尔病毒与多发性硬化症。
Nat Rev Microbiol. 2023 Jan;21(1):51-64. doi: 10.1038/s41579-022-00770-5. Epub 2022 Aug 5.
4
Pneumonia and Meningoencephalitis Due to Varicella-zoster Virus Reinfection and Epstein-Barr Virus Reactivation in a Patient with Rheumatoid Arthritis.一名类风湿关节炎患者因水痘-带状疱疹病毒再感染和EB病毒激活引发肺炎和脑膜脑炎
Intern Med. 2022 Oct 1;61(19):2961-2965. doi: 10.2169/internalmedicine.8413-21. Epub 2022 Mar 5.
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Epstein-Barr Virus and Neurological Diseases.爱泼斯坦-巴尔病毒与神经系统疾病
Front Mol Biosci. 2022 Jan 10;8:816098. doi: 10.3389/fmolb.2021.816098. eCollection 2021.
6
Clinical significance of Epstein-Barr virus in the cerebrospinal fluid of immunocompetent patients.免疫功能正常患者脑脊液中EB病毒的临床意义
Clin Neurol Neurosurg. 2021 Mar;202:106507. doi: 10.1016/j.clineuro.2021.106507. Epub 2021 Jan 19.
7
Primary Epstein-Barr virus infection in immunocompetent patients with acute transverse myelitis and a combination of polyradiculitis and anterior horn syndrome as neurological manifestations.免疫功能正常的患者中，原发性爱泼斯坦-巴尔病毒感染表现为急性横贯性脊髓炎，并伴有多发性神经根炎和前角综合征的组合作为神经学表现。
BMJ Case Rep. 2018 Aug 29;2018:bcr-2018-225333. doi: 10.1136/bcr-2018-225333.
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Dual Threat of Epstein-Barr Virus: an Autopsy Case Report of HIV-Positive Plasmablastic Lymphoma Complicating EBV-Associated Hemophagocytic Lymphohistiocytosis.爱泼斯坦-巴尔病毒的双重威胁：HIV 阳性浆母细胞淋巴瘤合并 EBV 相关噬血细胞性淋巴组织细胞增生症的尸检病例报告。
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