Long-Term Survival after Progressive Multifocal Leukoencephalopathy in a Patient with Primary Immune Deficiency and NFKB1 Mutation.

Autor: Maréchal E; Department of Neurology, ZNA Middelheim, Lindendreef 1, 2020, Antwerp, Belgium. emke.marechal@zna.be.; Department of Neurology, Antwerp University Hospital, Antwerp, Belgium. emke.marechal@zna.be., Beel K; Department of Hematology, ZNA Middelheim, Antwerp, Belgium., Crols R; Department of Neurology, ZNA Middelheim, Lindendreef 1, 2020, Antwerp, Belgium.; Department of Neurology, AZ Heilige Familie, Reet, Belgium., Hernalsteen D; Department of Radiology, ZNA Middelheim, Antwerp, Belgium., Willekens B; Department of Neurology, Antwerp University Hospital, Antwerp, Belgium.; Translational Neurosciences and Laboratory for Experimental Hematology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
Jazyk: angličtina
Zdroj: Journal of clinical immunology [J Clin Immunol] 2020 Nov; Vol. 40 (8), pp. 1138-1143. Date of Electronic Publication: 2020 Sep 11.
DOI: 10.1007/s10875-020-00862-y
Abstrakt: Purpose: To describe the development of progressive multifocal leukoencephalopathy (PML) in a patient with primary immune deficiency (PID) due to a NFKB1 (nuclear factor kB subunit 1) mutation, who was treated successfully with a combination of mirtazapine and mefloquine.
Methods: We've based the treatment of our patient on literature research and provide a review of PML in CVID patients.
Results: Only a few reports have been published on the occurrence of PML in PID. PML is mainly observed in patients with reduced cellular immunity, which was not the case in our patient. Successful treatment options in this population are limited. Though severely disabled, our patient still survives, more than 4 years after symptom onset and shows consistent improvement on MRI (magnetic resonance imaging) and CSF (cerebrospinal fluid) analysis.
Conclusion: We conclude that some patients with PML might be treatable and can show long-term survival although neurological deficits remain. Involvement of humoral immunity in the pathogenesis of PML as well as the possible role of NFKB1 mutations in response to specific pathogens deserves further investigation.
Databáze: MEDLINE
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