期刊
INTERNAL MEDICINE
卷 58, 期 22, 页码 3323-3329出版社
JAPAN SOC INTERNAL MEDICINE
DOI: 10.2169/internalmedicine.3038-19
关键词
progressive multifocal leukoencephalopathy (PML); rheumatoid arthritis (RA); JC virus; inflammation; methotrexate (MTX); cerebellum
资金
- Ministry of Education, Culture, Sports, Science, and Technology of Japan [18K07397, 17K09768]
- Grants-in-Aid for Scientific Research [17K09768, 18K07397] Funding Source: KAKEN
The patient was a 74-year-old woman with rheumatoid arthritis who developed ataxia. MRI revealed T2-hyperintense lesions predominantly in the left middle cerebellar peduncle. Punctate or linear Gd enhancement was also observed on T1-weighted images. A brain biopsy was conducted and the pathology revealed a mild demyelinated lesion. Polymerase chain reaction (PCR) of biopsied brain tissues revealed the presence of JC virus (JCV) DNA, but JCV-infected oligodendroglia-like cells were not apparent on immunohistochemistry. Sensitive in-situ hybridization, however, detected three JCV-positive cells and the infiltration of CD4(+) and CD 8(+) T cells and plasma cells was also observed. Immunosuppressants were tapered off and mirtazapine and mefloquine administered, resulting in a favorable outcome.
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