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増大特集 神経疾患と感染症update
文献概要
ナタリズマブ関連進行性多巣性白質脳症（PML）では，古典的なPMLの病理所見に加えてナタリズマブの除去に伴って発症する免疫再構築症候群（IRIS）の病理像の重畳がみられる。肥大アストロサイトと核内封入体を伴う巨大なオリゴデンドログリア，ミエリン貪食マクロファージの浸潤が前者に属し，後者の病理像としてCD8+T細胞を中心とする細胞浸潤と脳内JCウイルスの著減が観察される。本症の細胞浸潤はHIV関連PML-IRISのそれと比較してはるかに激烈であり，これは全身の免疫抑制を行わず血液脳関門での細胞移入を操作するナタリズマブの特性を反映した病理所見と考えられる。
参考文献
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