Progressive tumefactive inflammatory central nervous system demyelinating disease in an acquired immunodeficiency syndrome patient treated with highly active antiretroviral therapy
Progressive tumefactive inflammatory central nervous system demyelinating disease in an acquired immunodeficiency syndrome patient treated with highly active antiretroviral therapy
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DOI：
10.1080/13550280802304753
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发表时间：
2008-12-01
影响因子：
3.2
通讯作者：
Markovic-Plese, Silva
中科院分区：
文献类型：
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作者：
Lindzen, Eric;Jewells, Valerie;Markovic-Plese, Silva
我们在这里报告的情况下，进行性肿胀炎性中枢神经系统（CNS）脱髓鞘疾病的人类免疫缺陷病毒（HIV）血清阳性患者与高效抗逆转录病毒治疗（HAART）。活检显示弥漫性巨噬细胞和血管周围T淋巴细胞浸润伴严重脱髓鞘和相对轴突保留。该疾病以离心方式进展，累及双侧大脑白色物质，随后出现中央坏死变化和萎缩。停止HAART治疗，用皮下干扰素（IFN）β-1a治疗炎症性疾病。大量脑水肿通过静脉注射皮质类固醇控制，暴发性脑脊髓炎后，患者稳定，长期随访无疾病进展证据。我们认为，HAART重建的免疫应答可以揭示易感个体的自身免疫应答，类似于对预先存在的获得性免疫缺陷综合征（AIDS）机会性感染的增强免疫应答。考虑治疗方案。Journal of NeuroVirology（2008）14，569-573.
We report here a case of progressive tumefactive inflammatory central nervous system (CNS) demyelinating disease in a human immunodeficiency virus (HIV)-seropositive patient treated with highly active antiretroviral therapy (HAART). Biopsy revealed diffuse macrophage and perivascular T-lymphocytic infiltrates with severe demyelination and relative axonal sparing. The disease progressed in a centrifugal fashion, to involve bihemispheric cerebral white matter, with subsequent central necrotic changes and atrophy. Treatment with HAART was discontinued, and inflammatory disease was treated with subcutaneous interferon (IFN)beta-1a. Massive brain edema was controlled with courses of intravenous corticosteroids, Following fulminant monophasic disease, the patient stabilized with no evidence of disease progression over long-term follow up. We propose that immune response reconstituted by HAART can unmask an autoimmune response in susceptible individuals, analogous to the enhanced immune response to the preexisting acquired immunodeficiency syndrome (AIDS) opportunistic infections. Therapeutic options are considered. Journal of NeuroVirology (2008) 14, 569-573.