Neurology:弥漫性大B细胞淋巴瘤表现为双侧相继受累的动眼神经病变

2018-07-26 zyx整理 神经科病例撷英拾粹

56岁HIV感染男性,行联合抗逆转录病毒治疗(CD4计数:368个/μL;HIV-RNA <20拷贝/mL),近期去非洲旅游后相继出现双侧动眼神经麻痹。MRI

56岁HIV感染男性,行联合抗逆转录病毒治疗(CD4计数:368个/μL;HIV-RNA <20拷贝/mL),近期去非洲旅游后相继出现双侧动眼神经麻痹。MRI上可见动眼神经非增粗性强化(图1)。多次脑脊液检查提示淋巴细胞性细胞增多,未见肿瘤细胞。病程早期血清PCR分子检测提示恶性疟原虫阳性,尽管予以抗疟治疗,症状仍在进展。其他感染病因,包括新型隐球菌,组织胞浆菌病,水痘-带状疱疹病毒,单纯疱疹病毒和JC病毒等均已排除。患者后出现多颅神经病(双侧动眼神经,三叉神经,舌咽神经和迷走神经)和脑病,最终死于巨细胞病毒相关性心肺并发症。患者病程中未发现淋巴结肿大。尸检提示颅内和心包弥漫性大B细胞淋巴瘤(DLBCL)(图2)。孤立性动眼神经麻痹是DLBCL的罕见表现,见诸报道的病例少于20例。DLBCL,一种艾滋病定义性疾病(AIDS-defining illness),其发生风险随着CD4计数的减少而增加;但在CD4计数正常的HIV患者中也可出现。


(图1:横断面[A,C]和冠状位[B,D]MRI可见左侧[红箭]和右侧[绿箭]动眼神经的非增粗性强化)


(图2:A-B:HE染色提示弥漫性大B细胞淋巴瘤血管周围浸润;C-D:免疫组化染色提示B细胞标记物CD79a阳性;×10)

原始出处:Galla KM, Cameron-Smith E, Bares SH, et al. Teaching NeuroImages: Presentation of diffuse large B-cell lymphoma with bilateral sequentialoculomotor neuropathy. Neurology. 2018 Jul 3;91(1):e92-e93.

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    2018-07-27 axin012
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    2018-07-26 龙胆草

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