Progressive Multifocal Leukoencephalopathy with Balanced CD4/CD8 T-Cell Infiltration and Good Response to Mefloquine Treatment
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- Sanjo Nobuo
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Japan
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- Kina Satoko
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Japan
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- Shishido-Hara Yukiko
- Department of Anatomic Pathology, Tokyo Medical University, Japan
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- Nose Yurie
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Japan
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- Ishibashi Satoru
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Japan
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- Fukuda Tetsuya
- Department of Haematology, Tokyo Medical and Dental University, Japan
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- Maehara Taketoshi
- Department of Functional Neurosurgery, Tokyo Medical and Dental University, Japan
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- Eishi Yoshinobu
- Division of Surgical Pathology, Tokyo Medical and Dental University Hospital, Japan
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- Mizusawa Hidehiro
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Japan National Centre for Neurology and Psychiatry, National Centre Hospital, Japan
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- Yokota Takanori
- Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Japan
抄録
A 53-year-old man was admitted for sub-acute progressive dementia and Gerstmann syndrome. MRI demonstrated lesions in the white matter involving the left parietal lobe, accompanied by speckled or faint linear peripheral enhancement. Brain biopsy revealed JC virus infection in oligodendrocytes and balanced infiltration of CD8+ and CD4+ T lymphocytes. We diagnosed progressive multifocal leukoencephalopathy (PML) with controlled inflammation. The finding of CD4/CD8 T cells in the infected PML brain suggested therapeutically valuable immune system involvement, which we decided to preserve by withholding corticosteroids. We treated the patient with risperidone, cytarabine and mefloquine to suppress virus replication, but not with the corticosteroid that is conventionally used in inflammatory PML cases. The patient was discharged three months after admission, and one year later, his score on the Mini-Mental State Examination had recovered to 26/30, from 5/30 on admission.
収録刊行物
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- Internal Medicine
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Internal Medicine 55 (12), 1631-1635, 2016
一般社団法人 日本内科学会