Táborský P, Hrabánek J, Jirásek A, Matl I
Institut klinické a experimentální medicíny, Praha.
Vnitr Lek. 1998 Feb;44(2):108-10.
The authors describe the case of a 66-year-old female patient after transplantation of the kidney where a rare complication of immunosuppressive treatment was diagnosed--progressive multifocal leukoencephalopathy. The disease was manifested by gradually developing hemiparesis of the lower extremity five months after transplantation. Examination of the brain by computed tomography and examination of cerebrospinal fluid were normal. Subsequently the neurological finding developed into quadruparesis. Imaging of the brain by magnetic resonance revealed multiple demyelinization foci. In brain biopsy there were typical structures of progressive multifocal leukoencephalopathy and positive hybridization in situ for JC-virus in cell nuclei. Immunosuppressive treatment was restricted and ganciclovirus administration was started. Further progression of the clinical symptomatology ceased, the function of the transplanted kidney remained satisfactory. The patient died 14 months after the transplantation from sepsis. Examination of the post-mortem material revealed positivity of the JC-virus only in the cytoplasm of the affected cells. As effective treatment of infection with JC-virus is not known so far, the possible action of ganciclovirus is only speculative.
作者描述了一例66岁女性肾移植患者的病例，该患者被诊断出患有免疫抑制治疗的罕见并发症——进行性多灶性白质脑病。该病在移植后五个月表现为逐渐发展的下肢偏瘫。计算机断层扫描脑部检查和脑脊液检查均正常。随后，神经学检查结果发展为四肢瘫痪。磁共振脑部成像显示多个脱髓鞘病灶。脑活检显示有进行性多灶性白质脑病的典型结构，细胞核内JC病毒原位杂交呈阳性。免疫抑制治疗受到限制，并开始使用更昔洛韦。临床症状学的进一步进展停止，移植肾的功能仍令人满意。患者在移植后14个月死于败血症。尸检材料检查显示JC病毒仅在受影响细胞的细胞质中呈阳性。由于目前尚不知道治疗JC病毒感染的有效方法，更昔洛韦的可能作用仅是推测性的。
