Progresívna multifokálna leukoencefalopatia spojená s rituximabom

English version

Autoři: Juraj Sokol ¹; Lenka Lisá ¹; Jana Zeleňáková ²; Tomáš Balhárek ³; Ivana Plameňová ¹; Ján Staško ¹; Peter; Kubisz ¹
Působiště autorů: Department of Haematology and Transfusion Medicine, National Centre of Haemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovakia ¹; Department of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovakia ²; Department of Pathological Anatomy, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovakia ³
Vyšlo v časopise: Vnitř Lék 2017; 63(1): 60-64
Kategorie: Kazuistika

Souhrn

Progresívna multifokálna leukoencefalopatia (PML) bola prvýkrát popísaná v roku 1958 u pacienta s lymfoproliferatívnym ochorením. V roku 1971 bol izolovaný John Cunninghamov vírus (JCV), ktorý je zodpovedný za vznik tohto ochorenia. V našej práci popisujeme raritný prípad 62-ročného pacienta s chronickou lymfocytovou leukémiou a PML. Zároveň diskutujeme o diagnostických a terapeutických výzvach a ponúkame návrhy prevencie rozvoja PML. Hlavnými závermi práce sú: 1. Potrebný je pravidelný monitoring sérových hladín imunoglobulínov a pomeru CD4⁺ : CD8⁺ T-lymfocytov, podanie intravenóznych imunoglobulínov je potrebné zvážiť pri ich poklese. 2. Pri poklese pomeru CD4⁺ : CD8⁺ T-lymfocytov a nemožnosti podať intravenózne imunoglobulíny musíme zvážiť pokračujúci prínos podávania imunoterapie. 3. Pri objavení sa neurologickej symptomatológie u pacienta, ktorý podstupuje imunosupresívnu liečbu, musí lekár vysloviť podozrenie na možný rozvoj PML.

Kľúčové slová:
JC vírus – odporúčanie – progresívna multifokálna leukoencefalopatia – rituximab

Zdroje

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