Case report: Identification of Hepatitis B Virus in the cerebrospinal fluid of neuromyelitis optica spectrum disorders and successful treatment with ofatumumab and inebilizumab
Neuromyelitis optica spectrum disorder (NMOSD) is a rare demyelinating disease of the central nervous system primarily affecting the optic nerves, spinal cord, and brainstem. Viral infection may trigger NMOSD. Here, we report the case of a 34-year-old female presenting with a range of symptoms inclu...
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Frontiers Media S.A.
2024-02-01
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| Series: | Frontiers in Immunology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2024.1351782/full |
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| author | Linjun Cai Xu Liu Hongyu Zhou Jinmei Li Dong Zhou Dong Zhou Zhen Hong Zhen Hong Zhen Hong |
| author_facet | Linjun Cai Xu Liu Hongyu Zhou Jinmei Li Dong Zhou Dong Zhou Zhen Hong Zhen Hong Zhen Hong |
| author_sort | Linjun Cai |
| collection | DOAJ |
| description | Neuromyelitis optica spectrum disorder (NMOSD) is a rare demyelinating disease of the central nervous system primarily affecting the optic nerves, spinal cord, and brainstem. Viral infection may trigger NMOSD. Here, we report the case of a 34-year-old female presenting with a range of symptoms including nausea, vomiting, dysphagia, choking, and fatigue with unsteady gait, diplopia, hearing loss, left-sided facial paralysis, breathing difficulties, and hoarseness of voice. Her HBV DNA concentration, as determined by quantitative PCR analysis, exceeded 5×107 IU/ml in serum and 4.48×102 IU/ml in CSF. Next-generation sequencing of CSF revealed 1,528 HBV sequences in DNA analysis and 6 sequences in RNA analysis. Serum aquaporin-4 antibody (AQP4-Ab) titer was 1:10, and the CSF titer was 1:3.2. Brain magnetic resonance imaging showed high signal intensities in the brain stem, medulla oblongata, and left middle cerebellar peduncle with mild restricted-diffusion. The patient received antiviral and hepatoprotective medications before the high-dose methylprednisolone pulse therapy. However, the patient did not respond well to the first-line treatment. Subsequently, the patient received ofatumumab and inebilizumab. Throughout the follow-up period, there was a gradual improvement in her neurological symptoms, with no reactivation of hepatitis B or deterioration of liver function observed. Thereby, to the best of our knowledge, we report the first case of successful treatment with ofatumumab and inebilizumab in a patient with NMOSD concurrent with HBV infection. |
| first_indexed | 2024-03-08T00:46:02Z |
| format | Article |
| id | doaj.art-55560224efd447f296d0c68c22139cab |
| institution | Directory Open Access Journal |
| issn | 1664-3224 |
| language | English |
| last_indexed | 2024-03-08T00:46:02Z |
| publishDate | 2024-02-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Immunology |
| spelling | doaj.art-55560224efd447f296d0c68c22139cab2024-02-15T08:59:13ZengFrontiers Media S.A.Frontiers in Immunology1664-32242024-02-011510.3389/fimmu.2024.13517821351782Case report: Identification of Hepatitis B Virus in the cerebrospinal fluid of neuromyelitis optica spectrum disorders and successful treatment with ofatumumab and inebilizumabLinjun Cai0Xu Liu1Hongyu Zhou2Jinmei Li3Dong Zhou4Dong Zhou5Zhen Hong6Zhen Hong7Zhen Hong8Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, ChinaDepartment of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, ChinaDepartment of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, ChinaDepartment of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, ChinaDepartment of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, ChinaInstitute of Brain Science and Brain-inspired Technology of West China Hospital, Sichuan University, Chengdu, Sichuan, ChinaDepartment of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, ChinaInstitute of Brain Science and Brain-inspired Technology of West China Hospital, Sichuan University, Chengdu, Sichuan, ChinaDepartment of Neurology, Chengdu Shangjin Nanfu Hospital, Chengdu, Sichuan, ChinaNeuromyelitis optica spectrum disorder (NMOSD) is a rare demyelinating disease of the central nervous system primarily affecting the optic nerves, spinal cord, and brainstem. Viral infection may trigger NMOSD. Here, we report the case of a 34-year-old female presenting with a range of symptoms including nausea, vomiting, dysphagia, choking, and fatigue with unsteady gait, diplopia, hearing loss, left-sided facial paralysis, breathing difficulties, and hoarseness of voice. Her HBV DNA concentration, as determined by quantitative PCR analysis, exceeded 5×107 IU/ml in serum and 4.48×102 IU/ml in CSF. Next-generation sequencing of CSF revealed 1,528 HBV sequences in DNA analysis and 6 sequences in RNA analysis. Serum aquaporin-4 antibody (AQP4-Ab) titer was 1:10, and the CSF titer was 1:3.2. Brain magnetic resonance imaging showed high signal intensities in the brain stem, medulla oblongata, and left middle cerebellar peduncle with mild restricted-diffusion. The patient received antiviral and hepatoprotective medications before the high-dose methylprednisolone pulse therapy. However, the patient did not respond well to the first-line treatment. Subsequently, the patient received ofatumumab and inebilizumab. Throughout the follow-up period, there was a gradual improvement in her neurological symptoms, with no reactivation of hepatitis B or deterioration of liver function observed. Thereby, to the best of our knowledge, we report the first case of successful treatment with ofatumumab and inebilizumab in a patient with NMOSD concurrent with HBV infection.https://www.frontiersin.org/articles/10.3389/fimmu.2024.1351782/fullneuromyelitis optica spectrum disordershepatitis B virusofatumumabinebilizumabcase report |
| spellingShingle | Linjun Cai Xu Liu Hongyu Zhou Jinmei Li Dong Zhou Dong Zhou Zhen Hong Zhen Hong Zhen Hong Case report: Identification of Hepatitis B Virus in the cerebrospinal fluid of neuromyelitis optica spectrum disorders and successful treatment with ofatumumab and inebilizumab Frontiers in Immunology neuromyelitis optica spectrum disorders hepatitis B virus ofatumumab inebilizumab case report |
| title | Case report: Identification of Hepatitis B Virus in the cerebrospinal fluid of neuromyelitis optica spectrum disorders and successful treatment with ofatumumab and inebilizumab |
| title_full | Case report: Identification of Hepatitis B Virus in the cerebrospinal fluid of neuromyelitis optica spectrum disorders and successful treatment with ofatumumab and inebilizumab |
| title_fullStr | Case report: Identification of Hepatitis B Virus in the cerebrospinal fluid of neuromyelitis optica spectrum disorders and successful treatment with ofatumumab and inebilizumab |
| title_full_unstemmed | Case report: Identification of Hepatitis B Virus in the cerebrospinal fluid of neuromyelitis optica spectrum disorders and successful treatment with ofatumumab and inebilizumab |
| title_short | Case report: Identification of Hepatitis B Virus in the cerebrospinal fluid of neuromyelitis optica spectrum disorders and successful treatment with ofatumumab and inebilizumab |
| title_sort | case report identification of hepatitis b virus in the cerebrospinal fluid of neuromyelitis optica spectrum disorders and successful treatment with ofatumumab and inebilizumab |
| topic | neuromyelitis optica spectrum disorders hepatitis B virus ofatumumab inebilizumab case report |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2024.1351782/full |
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