Progressive Multifocal Leukoencephalopathy with Balanced CD4/CD8 T-Cell Infiltration and Good Response to Mefloquine Treatment
Progressive Multifocal Leukoencephalopathy with Balanced CD4/CD8 T-Cell Infiltration and Good Response to Mefloquine Treatment
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DOI：
10.2169/internalmedicine.55.6051
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发表时间：
2016-01-01
影响因子：
1.2
通讯作者：
Yokota, Takanori
中科院分区：
文献类型：
--
作者：
Sanjo, Nobuo;Kina, Satoko;Yokota, Takanori
1例53岁男性因亚急性进行性痴呆和格斯特曼综合征入院治疗。MRI显示累及左侧顶叶的白质病变，伴有斑点状或淡淡的线状周边强化。脑组织活检显示JC病毒感染少突胶质细胞，CD8+和CD4+T淋巴细胞均衡浸润。我们诊断为炎症受控的进行性多灶性白质脑病(PML)。在感染的PML脑中发现了CD4/CD8T细胞，这表明免疫系统参与了治疗，我们决定通过不使用皮质类固醇来保存这种免疫系统。我们用利培酮、阿糖胞苷和甲氟喹来抑制病毒复制，但没有使用传统上用于炎症性PML病例的皮质类固醇。患者在入院三个月后出院，一年后，他的简易精神状态检查分数从入院时的5/30恢复到26/30。
A 53-year-old man was admitted for sub-acute progressive dementia and Gerstmann syndrome. MRI demonstrated lesions in the white matter involving the left parietal lobe, accompanied by speckled or faint linear peripheral enhancement. Brain biopsy revealed JC virus infection in oligodendrocytes and balanced infiltration of CD8+ and CD4+ T lymphocytes. We diagnosed progressive multifocal leukoencephalopathy (PML) with controlled inflammation. The finding of CD4/CD8 T cells in the infected PML brain suggested therapeutically valuable immune system involvement, which we decided to preserve by withholding corticosteroids. We treated the patient with risperidone, cytarabine and mefloquine to suppress virus replication, but not with the corticosteroid that is conventionally used in inflammatory PML cases. The patient was discharged three months after admission, and one year later, his score on the Mini-Mental State Examination had recovered to 26/30, from 5/30 on admission.