肿瘤细胞治疗研究
英文原题：Unmasking Sapovirus: Chronic Enteritis in an Immunocompromised Adult With Hypogammaglobulinemia.
Unmasking Sapovirus: Chronic Enteritis in an Immunocompromised Adult With Hypogammaglobulinemia.
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Sapovirus是急性病毒性胃肠炎的已知病因，主要影响儿童和老年人。在免疫功能正常者中通常具有自限性，但在免疫功能低下患者中可导致持续、严重的胃肠道疾病。慢性Sapovirus肠炎仍未得到充分认识，也缺少标准化治疗指南。
我们报告一例69岁女性患者，患有多发性骨髓瘤，并因嵌合抗原受体（CAR）T细胞治疗继发严重低丙种球蛋白血症，因慢性水样腹泻10个月就诊。影像显示慢性肠炎征象，粪便PCR检测发现持续排出Sapovirus。内镜活检显示上皮细胞凋亡，组织学表现类似1级移植物抗宿主病（GVHD），但患者既往未接受移植。患者对皮质类固醇和静脉注射免疫球蛋白（IVIG）无应答。随后接受nitazoxanide治疗，临床症状显著改善、体重增加，随访时病毒排出完全清除。患者出院后接受每月IVIG和pegfilgrastim治疗，以支持免疫功能。本病例凸显免疫功能低下宿主慢性Sapovirus肠炎的诊断和管理挑战。黏膜免疫受损，尤其是免疫球蛋白A（IgA）缺乏，可能导致病毒持续感染。组织学表现可能类似GVHD样损伤，进一步增加诊断难度。目前无获FDA批准的治疗，但nitazoxanide和免疫球蛋白等疗法可能有益；不过，这些观察仍属探索性发现，需在更大队列中进一步研究。
Sapovirus is a recognized cause of acute viral gastroenteritis, predominantly affecting children and older adults. While typically self-limiting in immunocompetent individuals, sapovirus can result in persistent, severe gastrointestinal illness in immunocompromised patients. Chronic sapovirus enteritis remains underrecognized and lacks standardized treatment guidelines.
We report the case of a 69-year-old woman with multiple myeloma and profound hypogammaglobulinemia secondary to chimeric antigen receptor (CAR) T-cell therapy who presented with a 10-month history of chronic watery diarrhea. Imaging revealed features of chronic enteritis, and stool polymerase chain reaction (PCR) identified persistent sapovirus shedding. Endoscopic biopsy showed epithelial apoptosis with histologic features mimicking grade 1 graft-versus-host disease (GVHD) in the absence of prior transplantation. The patient failed to respond to corticosteroids and intravenous immunoglobulin (IVIG). She was subsequently treated with nitazoxanide, resulting in marked clinical improvement, weight gain, and complete clearance of viral shedding at follow-up.
She was discharged home on a regimen of monthly IVIG and pegfilgrastim for immune support. This case highlights the challenges in diagnosing and managing chronic sapovirus enteritis in immunocompromised hosts. Impaired mucosal immunity, particularly immunoglobulin A (IgA) deficiency, likely contributes to viral persistence.
Histologic findings may mimic GVHD-like injury, further complicating diagnosis. While no Food and Drug Administration (FDA)-approved treatments exist, therapies such as nitazoxanide and immunoglobulin may offer benefit; however, these observations remain exploratory and require further study in larger cohorts.
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