Guillain-Barre syndrome in a patient with multiple myeloma after bortezomib therapy: A case report
Guillain-Barre syndrome in a patient with multiple myeloma after bortezomib therapy: A case report
复制标题
多发性骨髓瘤患者硼替佐米治疗后出现格林-巴利综合征：病例报告
DOI：
10.12998/wjcc.v7.i18.2905
复制
发表时间：
2019-09-26
影响因子：
1.1
通讯作者：
Luo, Jun
中科院分区：
文献类型：
--
作者：
Xu, Yu-Ling;Zhao, Wei-Hua;Luo, Jun
背景：Bortezomib是被批准用于多发性骨髓瘤(MM)患者的一线药物，并显著提高了他们的总存活率。然而，Bortezomib诱导的周围神经病变(PN)仍然是一个严重的副作用，导致一些患者停止使用它。格林-巴利综合征(GBS)被认为是一种免疫介导的PN，其特征是累及多个神经根和周围神经，并在脑脊液(CSF)试验中出现蛋白细胞解离。静脉注射免疫球蛋白(IVIG)和血浆置换有效。病例摘要1例45岁男性确诊为III期MM(λ型)，接受了硼替佐米和地塞米松治疗。第二个疗程后14天，他主诉小腿和手部有强烈的灼烧感，触觉丧失，双腿远端和手腕关节远端疼痛。神经系统检查显示膝关节和脚踝反射消失。脑脊液检查显示蛋白细胞学解离。神经传导检查显示感觉神经动作电位波幅、传导速度减慢、F波潜伏期延长。他被诊断为MM合并GBS。随后，他接受大剂量静脉注射丙种球蛋白(400 mg/kg/d，连续5天)。在6个月的随访中，他的症状完全消失，没有复发。结论本病例强调对MM患者应用波特佐米治疗后并发症的鉴别诊断和处理。
BACKGROUND Bortezomib is a first-line drug approved for patients with multiple myeloma (MM) and has significantly increased their overall survival. However, bortezomib-induced peripheral neuropathy (PN) remains a significant side effect that has led to its discontinuation in some patients. Guillain-Barré syndrome (GBS) is recognized as an immune-mediated PN characterized by the involvement of multiple nerve roots and peripheral nerves and albuminocytologic dissociation in cerebrospinal fluid (CSF) tests. Intravenous immunoglobulin (IVIG) and plasmapheresis are effective. CASE SUMMARY A 45-year-old man diagnosed with stage III MM (λ type) was treated with bortezomib and dexamethasone. Fourteen days after the second course, he complained of intense burning sensation in the lower limbs and hands, loss of tactile sensation, and pain in the distal area of both thighs and in the distal part of both wrist joints. Neurological examination revealed absence of knee and ankle reflexes. CSF examination revealed albuminocytologic dissociation. Nerve conduction studies indicated sensory nerve action potential amplitudes, conduction velocity decrease, and F wave latency prolongation. He was diagnosed as MM complicated with GBS. Subsequently, he was treated with high-dose IVIG (400 mg/kg/d for five days). His symptoms fully resolved without relapse at the 6-month follow-up. CONCLUSION Our case highlights the differential diagnosis and management of complications after bortezomib treatment in MM.