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首页> 外文期刊>Journal of Clinical Medicine Research >Immune Reconstitution Inflammatory Syndrome Mimicking Progressive Multifocal Leucoencephalopathy in a Multiple Sclerosis Patient Treated With Natalizumab: A Case Report and Review of the Literature
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Immune Reconstitution Inflammatory Syndrome Mimicking Progressive Multifocal Leucoencephalopathy in a Multiple Sclerosis Patient Treated With Natalizumab: A Case Report and Review of the Literature

机译：纳他珠单抗治疗的多发性硬化患者中模拟进行性多灶性白质脑病的免疫重建炎症综合症：1例报道并文献复习

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Natalizumab (NTM) represents an effective drug for the treatment of relapsing-remitting multiple sclerosis (RRMS). Progressive multifocal leucoencephalopathy (PML) is a potential life-threatening complication of NTM treatment. A close follow-up and MRI monitoring of patients under NTM are required to avoid such devastating complications. The case of a 47-year-old woman with RRMS (EDSS 1.5) treated with NTM for 44 months is reported. The patient had a relapse with mild cerebellar symptomatology and visual complaints. MRI revealed a new area of abnormal signal intensity in the subcortical white matter of the right parietal lobe with mild peripheral enhancement. Visual fields showed scotomata mostly of the left eye. NTM was discontinued. JC virus (JCV) polymerase chain reaction (PCR) in cerebrospinal fluid was negative. The patient received IV corticosteroids for 5 days and then monthly for 2 months with subsequent clinical and MRI improvement. On month 4, she presented with a new relapse with severe ataxia, mild behavioral change, increase of cerebellar symptoms and internuclear opthalmoplegia (EDSS 3.5). MRI showed reappearance of the right parietal lobe lesion, with decreased size and less pronounced contrast enhancement. A new 2-cm lesion was noted in the left cerebellar hemisphere with a speckled pattern of contrast enhancement. JCV PCR was negative and the patient was treated with IV corticosteroids. On month 12, she demonstrated clinical and MRI improvement. Although initially PML was highly suspected in this patient, the clinical and MRI findings were supportive of the presence of immune reconstitution inflammatory syndrome (IRIS).J Clin Med Res. 2015;7(1):65-68doi: http://dx.doi.org/10.14740/jocmr1888w
机译：纳他珠单抗（NTM）代表一种治疗复发缓解型多发性硬化症（RRMS）的有效药物。进行性多灶性白质脑病（PML）是NTM治疗潜在的威胁生命的并发症。为了避免这种破坏性并发症，需要对NTM患者进行密切随访和MRI监测。据报道，一名47岁的妇女接受NTM治疗44个月，RRMS（EDSS 1.5）。该患者复发，伴有轻度小脑症状和视觉不适。 MRI显示右顶叶皮层下白质中有一个新的异常信号强度区域，周围区域轻度增强。视野显示大部分是左眼。 NTM已终止。脑脊液中的JC病毒（JCV）聚合酶链反应（PCR）为阴性。患者接受静脉糖皮质激素治疗5天，然后每月接受2个月，随后临床和MRI改善。在第4个月，她出现了新的复发，伴有严重的共济失调，轻度的行为改变，小脑症状加重和核间眼肌麻痹（EDSS 3.5）。 MRI显示右顶叶病变重新出现，大小减小且对比度增强不明显。在左小脑半球中发现了一个新的2 cm病变，有斑点的对比度增强模式。 JCV PCR阴性，该患者接受静脉注射糖皮质激素治疗。第12个月，她表现出临床和MRI改善。尽管最初在该患者中高度怀疑PML，但临床和MRI检查结果支持免疫重建炎症综合症（IRIS）的存在。 2015; 7（1）：65-68doi：http://dx.doi.org/10.14740/jocmr1888w

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