Progressive Multifocal Leukoencephalopathy as a Complication of Lymphoma Therapy – a Case Report
Authors:
M. Vališ 1; D. Belada 2; R. Taláb 1; M. Hrudková 2; J. Masopust 3; H. Hornychová 4; L. Klzo 5; M. Kanta 6; J. Malý 2
Authors‘ workplace:
LF UK a FN Hradec Králové: 1Ne urologická klinika, 2II. interní klinika, 3Psychi atrická klinika, 4Fingerlandův ústav patologie, 5Radiologická klinika, 6Neurochirurgická klinika
Published in:
Cesk Slov Neurol N 2009; 72/105(2): 159-161
Category:
Case Report
Overview
We are describing the case of a 69- ye ar- old male pati ent who had been tre ated since the ye ar 2000 for chronic lymphocytic le ukemi a. Initi ally, he was tre ated with cytostatic agents and rituximab. After the third progressi on of the dise ase, the pati ent received fo ur cycles of FCR (Fludarabine, Cyclophosphamide, Rituximab) since May 2006 with the achi evement of complete remissi on. Two months after the completi on of the therapy, the pati ent developed organic psychosyndrome with right- sided hemiparesis. Evalu ati on of the pati ent’s brain using magnetic resonance imaging (MRI) reve aled multiple non‑expanding lesi ons in the white matter in both frontal lobes, non‑opacifying after the administrati on of a contrast agent. Electron microscope examinati on demonstrated JC virus in the cerebrospinal fluid and also in the blo od and urine. Despite antiviral tre atment with high dose of aciclovir, the pati ent’s clinical conditi on progressed into qu adriplegi a during several days. Subsequently the pati ent developed a comatose conditi on with fatal septic shock. Immunohistochemical examinati on of the white matter demonstrated presence of the JC virus and massive demyelinati on. The case was concluded as a rare progressive multifocal le ukoencephalopathy in an immunocompromised pati ent tre ated for a lymphoproliferative dise ase.
Key words:
progressive multifocal le ukoencephalopathy – immunosuppressi on – rituximab – JC virus – lymphoproliferative disorders
Sources
1. Tornatore C, Amemiya K, Atwo od W, Conant K, Major EO, Berger J. JC virus: current concepts and controversi es in the molecular virology and pathogenesis of progressive multifocal le ukoencephalopathy. Rev Med Virol 1994; 4(3): 197– 219.
2. Pelosini M, Focosi D, Rita F, Galimberti S, Caracci olo F,Benedetti E et al. Progressive multifocal le ukoencephalopathy: report of three cases in HIV- negative hematological pati ents and revi ew of literature. Ann Hematol 2008; 87(5): 405– 412.
3. Berger JR, Lorraine P, Do uglas Lanska, Whiteman M. Progressive multifocal le ukoencephalopathy in pati ents with HIV infecti on. J Ne urovirol 1998; 4: 59– 68.
4. Astrom KE, Mancall EL, Richardson EP jr. Progressive multifocal le ukoencephalopathy. A hitherto unrecognized complicati on of chronic lymphocytic le ukaemi a and Hodgkin’s dise ase. Brain 1958; 81(1): 93– 111.
5. Mangi H, Miller RF. Progressive multifocal le ukoencephalopathy: progress in the AIDS era. J Ne urol Ne urosurg Psychi atry 2000; 69(5): 569– 571.
6. Gordon HY, Hidvegi DF, Cajulis RS, Brody BA, Levy RM. Cytomorphology of Progressive Multifocal Le ukoencephalopathy (PML). Di agnostic Cytopathology 1996; 14: 4– 9.
7. Chowdhary S, Chalmers LM, Chamberlein M. Non- HIV‑related progressive multifocal le ucoencephalopathy (PML): a terti ary cancer center experi ence. J Ne uro imaging 2007; 17(1): 69– 73.
8. Cinque P, Vaga L, Dahl H, Brytting M, Terreni MR, Fornara C et al. Polymerase chain re acti on on cerebrospinal fluid re acti on for di agnosis of virus associ ated opportunistic dise ase of the central nervo us system in HIV- infected pati ents. AIDS 1996; 10(9): 951– 958.
9. Garvey L, Thomson EC, Taylor GP. Progressive multifocal le ukoencephalopathy: prolonged survival in pati ents tre ated with prote ase inhibitors and cidofovir: a case seri es. AIDS 2006; 20(5): 791– 793.
10. Sanchez CA, Garci a- Gil D, Martinez SS, Lama GM, Gonzalez SA, Quirell BA,Progressive multifocal le ukoencephalopathy in acquired immunodefici ency syndrome. Rev Clin Esp 1994; 194: 13– 16.
Labels
Paediatric neurology Neurosurgery NeurologyArticle was published in
Czech and Slovak Neurology and Neurosurgery
2009 Issue 2
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