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

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.