Epstein-Barr病毒陽性之多發性骨髓瘤發生在患有幼年特發性關節炎的16歲青少女：案例報告

Epstein-Barr virus-positive multiple myeloma in a 16-year-old female adolescent with juvenile idiopathic arthritis: A case report

多發性骨髓瘤（MM）是一種與年齡相關的B細胞血液系統惡性腫瘤，其特徵是骨髓中克隆性漿細胞的增殖，導致單一克隆丙種球蛋白病變。它主要發生在老年患者中，很少見於兒童。我們發表了一個有幼年特發性關節炎（JIA）病史的16歲女孩案例，她表現為右眼下垂和胸痛，最終被診斷為MM。在右側第11肋椎交界處的骨和骨髓進行切片檢查，證實了診斷。在活檢標本的腫瘤細胞中，通過EBV編碼的RNA（EBER）的原位雜交檢測到Epstein-Barr病毒（EBV）。該患者對cyclophosphamide、類固醇和蛋白酶體抑製劑（bortezomib）的治療表現出良好的反應，並接受了自體造血幹細胞移植。據我們所知，這是第一例JIA患者被確診為MM，也是台灣確診MM中最年輕的患者。

Multiple myeloma (MM) is an age-related B-cell hematological malignancy characterized by the proliferation of clonal plasma cells in bone marrow, which results in monoclonal gammopathy. It occurs mostly in older patients and has been rarely reported in children. We present the case of a 16-year-old girl with a history of juvenile idiopathic arthritis (JIA) who presented with right eye ptosis and chest pain and was finally diagnosed with MM. The diagnosis was confirmed upon the biopsy in the bone of the right 11th costovertebral junction and bone marrow. The Epstein-Barr virus (EBV) was detected through in situ hybridization of EBV-encoded RNA (EBER) in neoplastic cells from the biopsy specimen. The patient exhibited a favorable response to therapy with cyclophosphamide, dexamethasone, and proteasome inhibitor (bortezomib) and underwent autologous hematopoietic stem cell transplantation. To our knowledge, this is the first case of a patient with JIA being diagnosed with MM, and the patient was the youngest in Taiwan to be diagnosed with MM.