急性淋巴细胞白血病合并复发性单纯疱疹病毒性脑炎患儿1例报告并文献复习  

ACUTE LYMPHOBLASTIC LEUKEMIA WITH RECURRENT HERPES SIMPLEX ENCEPHALITIS:A CASE REPORT AND LITERATURE REVIEW

作　　者：程晓玉 泥永安[1] 王玲珍[1] 赵艳霞[1] 张颖[2] 李学荣[1] CHENG Xiaoyu;NI Yongan;WANG Lingzhen;ZHAO Yanxia;ZHANG Ying;LI Xuerong(Department of Pediatric Hematology and Oncology,The Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院儿童血液肿瘤科,山东青岛266003 [2]青岛大学附属医院儿童神经内科,山东青岛2660032

出　　处：《精准医学杂志》2023年第5期440-443,共4页Journal of Precision Medicine

基　　金：山东省青岛市医疗卫生优秀人才培养项目(J14LL-06)。

摘　　要：目的探讨儿童急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)合并单纯疱疹病毒性脑炎(herpes simplex virus encephalitis,HSE)的临床特点及诊疗方案。方法收集我院收治的1例ALL合并复发性HSE患儿的临床资料,并结合文献进行复习。结果患儿,男,9岁,在ALL(中危)诱导缓解治疗期间出现发热、嗅觉异常、意识及认知障碍、近期记忆力减退、性格改变等表现;脑脊液常规检查示白细胞轻度增多(以单个核细胞为主),脑脊液生化检查示蛋白轻度升高,颅脑MR检查示双侧颞岛叶和右侧额叶后部见片状长T_(1)长T_(2)信号影,脑脊液病原微生物高通量测序示单纯疱疹病毒1型阳性;给予阿昔洛韦抗病毒、甲泼尼龙抗炎及丙种球蛋白免疫支持治疗后患儿症状逐渐消失,脑脊液常规及生化检查恢复正常。抗病毒治疗停止5个月后,患儿再诱导化疗期间HSE复发,再次给予阿昔洛韦治疗后临床症状好转。结论儿童ALL并发HSE在临床上较为少见,高强度化疗可能诱发HSE,其临床表现或不典型,早期发现、及早治疗有助于改善预后。Objective To investigate the clinical features of children with acute lymphoblastic leukemia(ALL)and herpes simplex encephalitis(HSE)and related diagnosis and treatment regimens.Methods Related clinical data were collected from a child with ALL and recurrent HSE who were admitted to our hospital,and a literature review was performed.Results A boy,aged 9 years,developed the manifestations of pyrexia,abnormal olfactory function,disturbance of consciousness and cognitive impairment,memory loss,and personality changes during remission induction therapy for ALL(intermediate-risk).Routine cerebrospinal fluid examination showed mild leukocytosis(mainly mononuclear cells);biochemical examination of cerebrospinal fluid showed a mild increase in protein;cranial MR showed patchy long T_(1) and long T_(2) signal shadows in the bilateral temporal insula and the right posterior frontal lobe;high-throughput sequencing of pathogenic microorganism in cerebrospinal fluid showed positive herpes simplex virus type 1.The symptoms gradually disappeared after antiviral therapy with acyclovir,anti-inflammatory therapy with methylprednisolone,and immune supportive therapy with gamma-globulin,with normal results of routine cerebrospinal fluid examination and biochemical examination.At 5 months after the cessation of antiviral therapy,the child had the recurrence of HSE during induction chemotherapy,and his clinical symptoms were improved after acyclovir treatment.Conclusion ALL comorbid with HSE is rare in children,and high-intensity chemotherapy may induce HSE.Due to a lack of typical clinical manifestations,early identification and treatment may help to improve prognosis.

关 键 词：前体细胞淋巴母细胞白血病淋巴瘤 脑炎 单纯疱疹 儿童 病例报告 

分 类 号：R733.711[医药卫生—肿瘤] R725.123[医药卫生—临床医学]