症例報告 脳脊髄液中のJCV-DNA遺伝子検査が2回とも陰性であったが,開頭脳生検で診断確定したHIV関連進行性多巣性白質脳症の1例
症例報告 脳脊髄液中のJCV-DNA遺伝子検査が2回とも陰性であったが,開頭脳生検で診断確定したHIV関連進行性多巣性白質脳症の1例
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病例报告：一例 HIV 相关进行性多灶性白质脑病，尽管脑脊液 JCV-DNA 基因检测两次均为阴性，但仍通过开放性脑活检确诊。
DOI：
10.11477/mf.1416201559
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Hamano T.
中科院分区：
文献类型：
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作者：
Kitazaki Y;Iwasaki H;Kitai R;Takahashi K;Nakamichi K;Hamano T.
一位感染人类免疫缺陷病毒（HIV）的36岁男性因进行性共济失调而入院。脑MRI示右侧顶叶白质及左侧小脑半球t2加权高信号。尽管接受了抗逆转录病毒治疗，但随着临床症状恶化，MRI病变逐渐增加，出现钆增强病变，怀疑与HIV感染相关的进行性多灶性白质脑病（PML）引起的免疫重建炎症综合征。而脑脊液中JC病毒（JCV）用DNA PCR检测两次均未检出。因此，对右顶叶进行活检。活检标本采用PCR检测JCV DNA。免疫组化检测JC病毒蛋白。当重复DNA PCR检测脑脊液JCV阴性时，临床诊断PML应考虑脑活检。（2019年9月20日收稿，2020年1月14日收稿，2020年5月1日发表）。
A 36-year-old man with human immunodeficiency virus (HIV) infection was admitted to our hospital due to progressive ataxia. Brain MRI demonstrated high-signal intensity in the white matter of the right parietal lobe and left cerebellar hemisphere on T2-weighted images. Despite antiretroviral therapy, as his clinical symptoms worsened and MRI lesions gradually increased with the appearance of gadolinium-enhanced lesions, immune reconstitution inflammatory syndrome by progressive multifocal leukoencephalopathy (PML) associated with HIV infection was suspected. However, JC virus (JCV) in the cerebrospinal fluid (CSF) was undetectable by DNA PCR twice. Therefore, biopsy of the right parietal lobe was performed. JCV DNA was detected by PCR using the biopsy sample. JC viral protein was also identified by immunohistochemistry. Brain biopsy should be considered for the clinical diagnosis of PML when CSF JCV is negative on repeated DNA PCR.(Received September 20, 2019; Accepted January 14, 2020; Published May 1, 2020).