A clinical case of the rituximab («Rituksim», «Mabthera») use to treat a man affected by the Chornobyl NPP acci dent with malignant resistant form of myasthenia gravis in conjunction with chronic mixed infection by Toxoplasma, Epstein Barr virus, Cytomegalovirus and Herpes simplex virus is described. In the dynamics of two year's observa tion the clinical efficacy of monoclonal antibodies was shown as the main symptoms stabilization and reducing doses of glucocorticoid and anticholinergic therapy. The positive effect was marked in the nearest and remote peri ods. Taking to account the efficacy, safety and good tolerability of rituximab, it is advisable to recommend treat ment for people exposed to ionizing radiation and developing myasthenia associated with chronic mixed infection by Toxoplasma, Epstein Barr, Cytomegalovirus and Herpes simplex virus.
Opysano klinichnyy̆ vypadok zastosuvannia rytuksymabu dlia likuvannia postrazhdalogo vnaslidok avariï na Chorno byl's'kiy̆ AES zi zloiakisnoiu rezystentnoiu formoiu miasteniï u poiednanni z khronichnoiu mikst infektsiieiu toksop lazmamy, virusamy Epshtey̆na Barr, tsytomegaliï i prostogo gerpesu. U dynamitsi dvorichnogo sposterezhennia poka zana klinichna efektyvnist' monoklonal'nykh antytil u vygliadi stabilizatsiï osnovnykh symptomiv i znyzhennia doz antykholinesteraznoï i gliukortykoïdnoï terapiï. Pozytyvnyy̆ efekt vidmichavsia v nay̆blyzhchyy̆ i viddalenyy̆ periody. Vrakhovuiuchy efektyvnist', bezpechnist' i dobru perenosymist' rytuksymabu, y̆ogo dotsil'no rekomendu vaty dlia likuvannia osib, iaki zaznaly vplyvu ionizuiuchoï radiatsiï i zakhvorily na miasteniiu, asotsiy̆ovanu z khronichnoiu mikst infektsiieiu toksoplazmamy, virusamy Epshtey̆na Barr, tsytomegaliï i prostogo gerpesu.
Keywords: Chornobyl disaster; monoclonal antibody; myasthenia gravis; myasthenic crises; persistent infection; rituximab; small doses of ionizing radiation.
V. I. Kravchenko, A. A. Chumak, K. M. Loganovsky, I. S. Diagil, V. F. Kuzmenko.