Dave Mili, Le Peter
Internal Medicine, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA.
Hospital Medicine, UNC Health REX Hospital, Raleigh, USA.
Cureus. 2025 Aug 27;17(8):e91152. doi: 10.7759/cureus.91152. eCollection 2025 Aug.
Prion diseases are fatal neurological disorders characterized by the accumulation of abnormal proteins in the central nervous system, leading to rapid neurodegeneration. We present a male his 70s who developed rapidly progressive dementia three weeks after a routine platelet-rich plasma (PRP) injection for chronic hip pain. MRI revealed multifocal cortical diffusion restriction involving the basal ganglia. CSF analysis via real-time quaking-induced conversion (RT-QuIC) confirmed prion disease, with elevated T-tau and 14-3-3 gamma proteins. He also tested seropositive for Ehrlichia, though other infectious causes were ruled out. Despite treatment with IV immunoglobulins (IGs) and antibiotics, his condition declined with worsening myoclonus and hyperreflexia. He died one week after discharge to hospice, six weeks after symptom onset. This case demonstrates several classic clinical features of sporadic Creutzfeldt-Jacob disease (sCJD) and raises the possibility that an acute inflammatory response from PRP injection may have triggered sCJD in the setting of a pre-existing chronic inflammatory state from tick-borne infection.
朊病毒病是一种致命的神经疾病，其特征是中枢神经系统中异常蛋白质的积累，导致快速的神经退行性变。我们报告了一名70多岁的男性，他在因慢性髋部疼痛接受常规富血小板血浆（PRP）注射三周后，出现了快速进展性痴呆。MRI显示基底节区有多灶性皮质扩散受限。通过实时震颤诱导转化（RT-QuIC）进行的脑脊液分析确诊为朊病毒病，T-tau和14-3-3γ蛋白升高。他的埃立克体血清学检测也呈阳性，不过排除了其他感染原因。尽管接受了静脉注射免疫球蛋白（IGs）和抗生素治疗，他的病情仍恶化，肌阵挛和反射亢进加重。出院转至临终关怀机构一周后，即症状出现六周后，他去世了。该病例展示了散发性克雅氏病（sCJD）的几个典型临床特征，并提出了在蜱传感染导致的预先存在的慢性炎症状态下，PRP注射引发的急性炎症反应可能触发sCJD的可能性。
