第504例——多发淋巴结肿大、肾功能不全、失明、脑白质病变  

The 504th case:Multiple lymph node enlargement,renal insufficiency,blindness,and white matter lesions of the brain

作　　者：魏冲 庄喆 李云龙 施潇潇 文煜冰 曹玮 范思远 张潇 张炎 张薇[1] 周道斌[1] Wei Chong;Zhuang Zhe;Li Yunlong;Shi Xiaoxiao;Wen Yubing;Cao Wei;Fan Siyuan;Zhang Xiao;Zhang Yan;Zhang Wei;Zhou Daobin(Department of Hematology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of Internal Medicine,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of Nephrology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of Infectious Disease,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of Neurology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of Ophthalmology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院、北京协和医学院、北京协和医院血液内科,北京100730 [2]中国医学科学院、北京协和医学院、北京协和医院内科,北京100730 [3]中国医学科学院、北京协和医学院、北京协和医院肾内科,北京100730 [4]中国医学科学院、北京协和医学院、北京协和医院感染科,北京100730 [5]中国医学科学院、北京协和医学院、北京协和医院神经科,北京100730 [6]中国医学科学院、北京协和医学院、北京协和医院眼科,北京100730

出　　处：《中华内科杂志》2024年第3期316-320,共5页Chinese Journal of Internal Medicine

摘　　要：患者男,65岁。因反复淋巴结肿大5年余,肌酐升高6个月入院。患者5年前明确诊断血管免疫母细胞性T细胞淋巴瘤,经历多线、多种抗肿瘤药物治疗,包括细胞毒化疗、表观调控药物西达本胺和阿扎胞苷、免疫调节剂来那度胺、靶向CD20的利妥昔单抗和靶向CD30的维布妥昔单抗。肿瘤虽得以稳定,但在抗肿瘤治疗的过程中出现多种病毒激活(包括BK病毒、JC病毒、巨细胞病毒)及相应靶脏器损伤(多瘤病毒肾病、巨细胞病毒视网膜炎、进行性多灶性白质脑病)。通过暂停肿瘤治疗以降低免疫抑制,并加用更昔洛韦抗病毒治疗后,血病毒载量下降,脏器功能得以稳定。本例患者的诊治过程提示临床医师,在抗肿瘤治疗的同时,需密切关注患者的免疫状态及病毒感染相关不良反应。A 65-year-old male patient was admitted for recurrent lymph node enlargement for 5 years and elevated creatinine for 6 months.This patient was diagnosed with angioimmunoblastic T-cell lymphoma 5 years ago and underwent multiple lines of anti-tumor therapy,including cytotoxic chemotherapy;epigenetic modifying drugs such as chidamide and azacitidine;the immunomodulator lenalidomide;and targeted therapy such as rituximab,a CD20-targeting antibody,and brentuximab vedotin,which targets CD30.Although the tumor was considered stable,multiple virus activation(including BK virus,JC virus,and cytomegalovirus)accompanied by the corresponding organ damage(polyomavirus nephropathy,cytomegalovirus retinitis,and progressive multifocal leukoencephalopathy)occurred during anti-tumor treatment.Anti-tumor therapy was suspended and ganciclovir was used.The serum viral load decreased and organ functions were stabilized.The purpose of this report was to raise clinicians′awareness of opportunistic virus reactivation during anti-tumor treatment.

关 键 词：淋巴瘤 巨细胞病毒视网膜炎 脑白质病 进行性多灶性 血管免疫母细胞性T细胞淋巴瘤 多瘤病毒相关肾病 

分 类 号：R732.2[医药卫生—肿瘤]