孢子虫脑脓肿:布鲁顿酪氨酸激酶抑制剂疗法的罕见致命缺点。

IF 1.3 Q4 HEMATOLOGY
Journal of hematology Pub Date : 2024-10-01 Epub Date: 2024-10-21 DOI:10.14740/jh1263
Matteo Dalmazzo, Melissa Padrini, Sofia Camerlo, Giorgio Rosati, Tiziano Tommaso Busana, Paolo Nicoli, Fabio Perotto, Luca Davicco, Pietro Caironi, Marco De Gobbi, Alessandro Morotti
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引用次数: 0

摘要

本病例报告中描述的患者因神志不清、嗜睡、口腔和眼球偏斜入住都灵圣路易吉医院。医生怀疑他患有急性神经系统疾病。他患有慢性淋巴细胞白血病(CLL),正在接受新型布鲁顿酪氨酸激酶抑制剂(BTKi)acalabrutinib的积极治疗。其他合并症包括II型糖尿病、动脉高血压和非酒精性脂肪性肝炎。影像学检查显示患者有多处脑部病变,似乎是感染性炎症引起的。因此,阿卡布替尼被暂停治疗。后来,由于神经系统状况恶化,患者被转入重症监护室。通过对最宽的脑部病灶进行立体定向活检,确诊为真菌性脓肿。微生物检测证实,病原体为Scedosporium spp.。在获得详细的抗生素图谱后,患者开始接受伏立康唑治疗。然而,患者的临床症状迅速恶化,后来死于神经系统并发症。BTKis 是治疗慢性淋巴细胞白血病的里程碑,但人们对这些分子如何作用于免疫系统却知之甚少。真菌性脑脓肿是一种罕见病,多见于免疫力严重低下的患者,如后天免疫缺陷综合征患者、骨髓移植后或急性白血病治疗后。使用 BTKis 治疗是否有利于机会性真菌感染仍是一个争论不休的问题。关于使用伊布替尼治疗后出现曲霉菌病感染的报道不一而足。有证据表明,先天性免疫系统的先天性损伤可能有利于这些感染。此外,患者的合并症,如糖尿病和进展中的血液病,可能为这些微生物的滋生创造了理想的温床。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Scedosporium Brain Abscess: A Rare and Fatal Drawback of Bruton Tyrosine Kinase Inhibitor Therapy.

The patient described in this case report was admitted to the San Luigi Hospital in Turin for confusion, drowsiness, and buccal and eye deviation. An acute neurological disease was suspected. He was affected by chronic lymphocytic leukemia (CLL) on active treatment with the novel Bruton tyrosine kinase inhibitor (BTKi) acalabrutinib. Other comorbidities included type II diabetes mellitus, arterial hypertension, and nonalcoholic steatohepatitis. Imaging exams showed multiple brain lesions, which appeared to be of infectious-inflammatory origin. Consequently, therapy with acalabrutinib was withheld. The patient was later transferred to the intensive care unit, because of worsening neurological conditions. The definite diagnosis of fungal abscess was obtained through a stereotactic biopsy of the widest brain lesion. Microbiological tests confirmed Scedosporium spp. as the etiological agent. Once a detailed antibiogram had been obtained, voriconazole therapy was started. However, the patient's clinical conditions decayed rapidly and he later died of neurological complications. BTKis represent a milestone in the treatment of CLL; however, little is known about how these molecules act on the immune system. Fungal brain abscesses are rare conditions more commonly seen in heavily immunocompromised patients, such as those affected by acquired immune deficiency syndrome, after bone marrow transplant or treatment for acute leukemia. Whether or not therapy with BTKis can favor opportunistic fungal infections is still a matter of debate. Various reports of Aspergillosis infections developing after therapy with ibrutinib exist. Evidence does suggest that an iatrogenic impairment in the innate immune system could favor these infections. In addition, the patient's comorbidities, such as diabetes mellitus and advancing hematological disease, might create the ideal breeding ground for these microorganisms.

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来源期刊
Journal of hematology
Journal of hematology HEMATOLOGY-
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