■巨细胞病毒(CMV)可在免疫功能低下的宿主中引起各种终末器官疾病,包括异基因造血细胞移植(allo-HSCT)受者。有趣的是,CMV病毒血症与allo-HSCT受者的各种并发症和不良预后有关。在allo-HSCT后,有9-14%的患者发生涉及中枢神经系统(CNS)的并发症。然而,在allo-HSCT后继发于CMV感染的自身免疫性脑炎(AE)很少有报道。在这里,我们报告了一例在allo-HSCT后CMV病毒血症后可能的AE,成功用大剂量脉冲甲基强的松龙和静脉免疫球蛋白(IVIg)治疗。
■一名53岁女性因T淋巴母细胞淋巴瘤/白血病接受allo-HSCT治疗。患者在移植后第36天出现CMV病毒血症,开始更昔洛韦抗病毒治疗后,血清CMV-DNA保持阳性,一个月后转为负值。四个月后,她开始出现记忆障碍,左四肢无力,认知功能障碍,和幻觉.磁共振成像脑部扫描显示双侧额叶皮质下的分散缺血性病变。下一代基因测序技术在脑脊液(CSF)中检测病毒未发现明显异常。血清和CSF中不存在特异于AE和副肿瘤疾病的抗体。使用等电聚焦和免疫固定检测CSF中的寡克隆条带,结果是阴性。然而,经过对感染的广泛调查,自身免疫性疾病,和恶性肿瘤的复发,不能排除可能的AE。患者接受大剂量类固醇联合IVIg治疗,患者症状明显改善。
■allo-HSCT后AE的机制以及与CMV感染的关系有待进一步研究。因此,报告这一病例和类似病例将提高我们对潜在疾病机制的认识和理解.
UNASSIGNED: Cytomegalovirus (CMV) can cause various end-organ diseases in immunocompromised hosts, including allogeneic hematopoietic cell transplant (allo-HSCT) recipients. Interestingly, CMV viremia has been associated with various complications and poor prognosis in allo-HSCT recipients. Complications involving the central nervous system (CNS) occur in 9-14% of patients following allo-HSCT. However, autoimmune encephalitis (AE) secondary to CMV infection after allo-HSCT has rarely been reported. Here we report a case of possible AE following CMV viremia after allo-HSCT, which was successfully treated with high-dose pulsed methylprednisolone and intravenous immunoglobulins (IVIg).
UNASSIGNED: A 53-year-old female underwent allo-HSCT for T-lymphoblastic lymphoma/leukemia. The patient developed CMV viremia on day 36 after transplantation, and serum CMV-DNA remained positive after initiating ganciclovir antiviral therapy, turning negative one month later. Four months later, she started experiencing memory impairment, weakness in the left limbs, cognitive dysfunction, and hallucinations. A magnetic resonance imaging brain scan showed scattered ischemic lesions under the bilateral frontal cortex. Viral detection in cerebral spinal fluid (CSF) by next-generation gene sequencing technology showed no obvious abnormality. Antibodies specific to AE and paraneoplastic diseases in serum and CSF were absent. The oligoclonal bands in the CSF were detected using isoelectric focusing and immunofixation, and the results were negative. However, after extensive investigation regarding infections, autoimmune disorders, and recurrence of the malignancy, possible AE could not be excluded. The patient was treated with high-dose steroids combined with IVIg therapy; the patient\'s symptoms were significantly improved.
UNASSIGNED: The mechanisms of AE after allo-HSCT and the relationship with CMV infection should be further studied. Therefore, reporting this and similar cases will improve our awareness and understanding of the underlying disease mechanisms.