A Case of Progressive Multifocal Leukoencephalopathy in a Patient Treated With Infliximab
A Case of Progressive Multifocal Leukoencephalopathy in a Patient Treated With Infliximab
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DOI：
10.1002/art.27687
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发表时间：
2010-11-01
影响因子：
--
通讯作者：
Berger, Robert G.
中科院分区：
文献类型：
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作者：
Kumar, Deepak;Bouldin, Thomas W.;Berger, Robert G.
我们描述了一名患有糜烂性类风湿性关节炎的 72 岁白人，在接受英夫利昔单抗、泼尼松和甲氨蝶呤治疗 3 年后出现亚急性神经和精神症状。大脑磁共振成像发现白质脱髓鞘，最终通过脑活检证实进行性多灶性白质脑病（PML）。该患者接受了支持疗法并停止使用缓解病情的抗风湿药物，从而使疾病过程稳定下来。患者幸存下来，但神经和认知缺陷仍然存在。该患者疾病的分布和病理学与几乎所有报道的口服甲氨蝶呤相关白质脑病事件不同。疾病的发病机制可能与 T 细胞介导的过程有关，该过程可能受到英夫利昔单抗的影响。该病例首次提供了证据表明 PML 与英夫利昔单抗治疗有关。
We describe a 72-year-old white man with erosive rheumatoid arthritis in whom subacute neurologic and psychiatric symptoms developed after 3 years of treatment with infliximab, prednisone, and methotrexate. White matter demyelination was seen on magnetic resonance imaging of the brain, and progressive multifocal leukoencephalopathy (PML) was ultimately confirmed by brain biopsy. The patient was treated with supportive therapy and discontinuation of disease-modifying antirheumatic drugs, resulting in stabilization of the disease process. The patient survived, but neurologic and cognitive deficits persisted. The distribution and pathology of this patient's disease are unique from almost all reported incidents of oral methotrexate-associated leukoencephalopathy. The pathogenesis of disease may be linked to a T cell-mediated process that is potentially impacted by infliximab. This case provides the first reported evidence that PML can be seen in association with infliximab therapy.