鞘内注射地塞米松辅助治疗重症带状疱疹病毒性脑膜脑炎1例报道

Intrathecal dexamethasone as adjunctive therapy for severe varicella-zoster virus meningoencephalitis: a case report

摘要:

该文报道1例78岁男性重症带状疱疹病毒性（VZV）脑膜脑炎患者，合并乙型肝炎病毒活动性复制。经静脉阿昔洛韦治疗，患者意识仍进行性加重，且存在全身激素禁忌，免疫评估提示，患者中枢神经系统存在严重炎症，即脑脊液中白细胞介素（IL）-6显著升高，同时伴有全身免疫抑制状态，表现为血清IL-6/IL-10比值显著增高至17.58，且CD4⁺ T细胞减少。遂在持续抗病毒及支持治疗的基础上，联合鞘内注射地塞米松（5 mg/次，连续3 d）辅助治疗。治疗后患者意识迅速转清，脑脊液中IL-6/IL-10比值降至0.78。治疗及随访期间，未出现与操作相关或全身性并发症。该病例提示，对于存在全身激素禁忌的重症患者，鞘内注射地塞米松或可作为一种能够精准作用于中枢神经系统、同时避免全身性免疫抑制风险的辅助治疗选择。动态监测脑脊液中IL-6/IL-10比值或有助于评估中枢神经系统炎症状态，但其价值需进一步研究验证。

Abstract:

This article reports a case of a 78-year-old male with severe varicella-zoster virus meningoencephalitis， complicated by active hepatitis B virus replication. Despite intravenous acyclovir treatment， his consciousness deteriorated progressively. Systemic corticosteroids were contraindicated. Immunological assessment revealed severe inflammation in the central nervous system， indicated by significantly elevated interleukin （IL）-6 levels in the cerebrospinal fluid （CSF）， accompanied by a systemic immunosuppressive state characterized by a markedly elevated serum IL-6/IL-10 ratio of 17.58 and reduced CD4⁺ T-cell counts. On the basis of continued antiviral and supportive therapy， adjunctive intrathecal dexamethasone （5 mg once daily for 3 consecutive days） was administered. Following treatment， the patient’s consciousness rapidly improved， and the CSF IL-6/IL-10 ratio decreased to 0.78. No procedure-related or systemic complications occurred during treatment or follow-up. This case suggests that for patients with severe varicella-zoster virus meningoencephalitis and contraindications to systemic corticosteroids， intrathecal dexamethasone may serve as a targeted adjunctive therapy that precisely modulates central nervous system inflammation while mitigating the risks of systemic immunosuppression. Dynamic monitoring of the CSF IL-6/IL-10 ratio may help assess the inflammatory status of the central nervous system， although its clinical value requires further validation.