A case of immune reconstitution syndrome complicating progressive multifocal leukoencephalopathy after kidney transplant: Clinical, pathological, and radiographic features.

Autor: Jackowiak E; Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania., Shah N; Division of Nephrology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania., Chen H; Division of Nephrology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania., Ojha A; Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania., Doyle J; Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania., Shepler A; Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania., Bogdanovich T; Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania., Silveira FP; Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania., Haidar G; Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Jazyk: angličtina
Zdroj: Transplant infectious disease : an official journal of the Transplantation Society [Transpl Infect Dis] 2019 Oct; Vol. 21 (5), pp. e13162. Date of Electronic Publication: 2019 Sep 03.
DOI: 10.1111/tid.13162
Abstrakt: Progressive multifocal leukoencephalopathy (PML) is a life-threatening central nervous system (CNS) disorder, most commonly described in patients infected with the human immunodeficiency virus (HIV). Limited data exist on its natural history and treatment in solid organ transplant (SOT) recipients. A complication of PML is the immune reconstitution inflammatory syndrome (IRIS), which develops after T cell reconstitution and can have severe consequences when it occurs in the CNS. While well described in HIV-infected individuals, its clinical features, diagnosis, and treatment after SOT are largely unknown. We report a case of a kidney transplant recipient who was diagnosed with PML and developed significant worsening of her symptoms upon reduction of immunosuppression. Thallium SPECT showed avid uptake suggestive of lymphoma, but the diagnosis of PML-IRIS was ultimately established by brain biopsy. She survived with nearly complete restoration of her functional status after a prolonged steroid taper.
(© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje