An Unusual Case of CMV/EBV Ventriculoencephalitis with Evolution to Primary Central Nervous System Lymphoma in HIV-Positive Patient.
An Unusual Case of CMV/EBV Ventriculoencephalitis with Evolution to Primary Central Nervous System Lymphoma in HIV-Positive Patient.
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DOI：
10.1155/2018/7683797
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发表时间：
2018
影响因子：
1.1
通讯作者：
Silva MJ
中科院分区：
文献类型：
--
作者：
Borges G;Neves D;Maury IP;Pereira A;Silva MJ
爱泼斯坦-巴尔病毒(Epstein-Barr Virus，EBV)是一种众所周知的多种恶性肿瘤的病因，尤其是Burkitt淋巴瘤、鼻咽癌、霍奇金淋巴瘤和包括原发性中枢神经系统淋巴瘤(PCNSL)在内的非霍奇金淋巴瘤。在免疫功能低下的患者中，如人类免疫缺陷病毒(HIV)感染的患者，与EBV相关的恶变趋势更高。快速有效的免疫重建是预防HIV阳性患者PCNSL的关键。我们提出了一例年轻患者的临床病例，诊断为HIV感染，接受了抗逆转录病毒治疗(ART)，但免疫功能恢复不佳。两周后，他出现脑室脑炎，在头颅磁共振成像(MRI)中观察到，由巨细胞病毒(CMV)和EB病毒(EBV)引起，两者血清病毒载量都很高，迅速演变为PCNSL。通过这一罕见的临床病例，作者希望引起人们注意快速免疫重建在防止EBV感染进展到PCNSL方面的重要性，并鼓励确认早期联合化疗和抗病毒治疗的有效性，以达到对这种疱疹病毒感染和相关恶性肿瘤的更有效的治疗。
Epstein–Barr virus (EBV) is a well-known cause of different types of malignancies particularly Burkitt's lymphoma, nasopharyngeal carcinoma, Hodgkin's lymphomas, and non-Hodgkin's lymphomas including primary central nervous system lymphoma (PCNSL). A higher tendency of malignant transformation associated with EBV has been noticed in immunocompromised patients, such as human immunodeficiency virus (HIV) infected patients. The rapid and effective immune reconstitution is crucial to prevent PCNSL in HIV-positive patients. We present a clinical case of a young patient diagnosed with HIV infection and medicated with antiretroviral therapy (ART) with poor immunological recovery. After two weeks, he developed ventriculoencephalitis, observed in the cranial magnetic resonance imaging (MRI), caused by cytomegalovirus (CMV) and EBV, both with high serum viral load, rapidly evolving to PCNSL. With this unusual clinical case, the authors want to draw attention to the importance of rapid immunological reconstitution in preventing the progression of EBV infection to PCNSL, as well as encouraging the confirmation of the usefulness of early combination of chemotherapy and antiviral therapy, in order to reach a more effective treatment of this herpesvirus infection and associated malignancies.
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