PDF(Pubmed)
Abstract：
UNASSIGNED: The hepatitis E virus (HEV) can cause acute viral hepatitis with or without neurological manifestations, and occasionally progresses to chronic infection in immunocompromised individuals. The management of chronic HEV infection in cancer patients may be challenging due to the complex immunological constellation. Furthermore, the diagnostic workflow and the impact on quality of life of neurological HEV manifestations in immunocompromised patients have not been sufficiently delineated previously.
UNASSIGNED: A 61-year-old male with systemically treated chronic lymphocytic leukemia (CLL) experienced a slowly progressive atrophy of the spinal cord due to a chronic HEV infection. Despite continuous antiviral treatment with ribavirin, the patient\'s neurological condition continued to deteriorate, particularly following subsequent attempts to treat CLL. Treatment with obinutuzumab resulted in acute bowel and urinary retention and a further deterioration of motor skills, prompting the discontinuation of obinutuzumab. The patient\'s neurological status improved after the administration of intravenous immunoglobulins.
UNASSIGNED: This case study provides a comprehensive long-term follow-up of a cancer patient with chronic HEV infection and associated CNS involvement, which resulted in progressive neurological disability over several years. The challenges faced in diagnosing new neurological symptoms in patients undergoing immunosuppressive cancer treatment underscore the need for an interdisciplinary diagnostic approach that includes HEV testing. We propose a diagnostic pathway for future validation in immunocompromised cohorts presenting with neurological symptoms, emphasizing its potential to enhance clinical outcomes.
UNASSIGNED: A 61-year-old male with systemically treated chronic lymphocytic leukemia (CLL) experienced a slowly progressive atrophy of the spinal cord due to a chronic HEV infection. Despite continuous antiviral treatment with ribavirin, the patient\'s neurological condition continued to deteriorate, particularly following subsequent attempts to treat CLL. Treatment with obinutuzumab resulted in acute bowel and urinary retention and a further deterioration of motor skills, prompting the discontinuation of obinutuzumab. The patient\'s neurological status improved after the administration of intravenous immunoglobulins.
UNASSIGNED: This case study provides a comprehensive long-term follow-up of a cancer patient with chronic HEV infection and associated CNS involvement, which resulted in progressive neurological disability over several years. The challenges faced in diagnosing new neurological symptoms in patients undergoing immunosuppressive cancer treatment underscore the need for an interdisciplinary diagnostic approach that includes HEV testing. We propose a diagnostic pathway for future validation in immunocompromised cohorts presenting with neurological symptoms, emphasizing its potential to enhance clinical outcomes.
摘要：
■戊型肝炎病毒（HEV）可引起急性病毒性肝炎，有或没有神经系统表现，偶尔在免疫功能低下的个体中进展为慢性感染。由于复杂的免疫学星座，癌症患者中慢性HEV感染的管理可能具有挑战性。此外，在免疫功能低下患者中,神经系统HEV表现的诊断工作流程和对生活质量的影响之前尚未得到充分描述.
■一名61岁的男性患有全身治疗的慢性淋巴细胞白血病（CLL），由于慢性HEV感染，出现了缓慢进行性的脊髓萎缩。尽管用利巴韦林持续抗病毒治疗，病人的神经状况继续恶化，特别是在随后尝试治疗CLL之后。使用obinutuzumab治疗导致急性肠和尿潴留以及运动技能的进一步恶化。提示停用obinutuzumab。静脉注射免疫球蛋白后，患者的神经状况得到改善。
■本案例研究对患有慢性HEV感染和相关中枢神经系统受累的癌症患者进行了全面的长期随访，这导致了几年的进行性神经残疾。在接受免疫抑制癌症治疗的患者中诊断新的神经症状所面临的挑战强调了对包括HEV测试的跨学科诊断方法的需求。我们提出了一种诊断途径，用于在出现神经系统症状的免疫受损队列中进行未来验证，强调其提高临床结果的潜力。
■一名61岁的男性患有全身治疗的慢性淋巴细胞白血病（CLL），由于慢性HEV感染，出现了缓慢进行性的脊髓萎缩。尽管用利巴韦林持续抗病毒治疗，病人的神经状况继续恶化，特别是在随后尝试治疗CLL之后。使用obinutuzumab治疗导致急性肠和尿潴留以及运动技能的进一步恶化。提示停用obinutuzumab。静脉注射免疫球蛋白后，患者的神经状况得到改善。
■本案例研究对患有慢性HEV感染和相关中枢神经系统受累的癌症患者进行了全面的长期随访，这导致了几年的进行性神经残疾。在接受免疫抑制癌症治疗的患者中诊断新的神经症状所面临的挑战强调了对包括HEV测试的跨学科诊断方法的需求。我们提出了一种诊断途径，用于在出现神经系统症状的免疫受损队列中进行未来验证，强调其提高临床结果的潜力。
