title: Effective immune restoration after immunosuppressant discontinuation in a lupus patient presenting progressive multifocal leukoencephalopathy.
abstract: Progressive multifocal leukoencephalopathy (PML) is an opportunistic infection of the central nervous system with JC virus. Few cases have been described in lupus patients. We describe biopsy-proven PML in a lupus patient receiving mycophenolate mofetil and corticosteroids. Although the patient received no antiviral treatment, the polymerase chain reaction test for JC virus became negative in cerebrospinal fluid after immunosuppressant discontinuation and the patient survived. We discuss the restoration of immune efficiency after immunosuppressant discontinuation in this case and compare the clinical, radiological and histological features with the inflammatory PML form described in human immunodeficiency virus-infected patients.
authors.affiliation: Department of Internal Medicine, National Reference Centre for Rare Systemic and Autoimmune Diseases (Systemic Sclerosis), Regional University Hospital and Henri Warembourg School of Medicine, Lille 2 University, Lille, France. guill_lefevre@hotmail.com
authors.forename: Guillaume
authors.initials: G
authors.lastname: Lefèvre
authors.forename: Viviane
authors.initials: V
authors.lastname: Queyrel
authors.forename: Claude-Alain
authors.initials: CA
authors.lastname: Maurage
authors.forename: Charles
authors.initials: C
authors.lastname: Laurent
authors.forename: David
authors.initials: D
authors.lastname: Launay
authors.forename: Arnaud
authors.initials: A
authors.lastname: Lacour
authors.forename: Hilaire
authors.initials: H
authors.lastname: Charlanne
authors.forename: Sandrine
authors.initials: S
authors.lastname: Morell-Dubois
authors.forename: Marc
authors.initials: M
authors.lastname: Lambert
authors.forename: Hélène
authors.initials: H
authors.lastname: Maillard
authors.forename: Patrick
authors.initials: P
authors.lastname: Vermersch
authors.forename: Eric
authors.initials: E
authors.lastname: Hachulla
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Hatron
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects; D001921:Brain / Q000276:immunology / Q000503:physiopathology / Q000821:virology; D005260:Female; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000276:immunology / Q000503:physiopathology / Q000517:prevention & control; D007107:Immune System / Q000187:drug effects / Q000276:immunology*; D016867:Immunocompromised Host / Q000187:drug effects / Q000276:immunology; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D007577:JC Virus / Q000187:drug effects / Q000276:immunology; D007968:Leukoencephalopathy, Progressive Multifocal / Q000276:immunology* / Q000503:physiopathology / Q000821:virology; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy*; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D020127:Recovery of Function / Q000187:drug effects / Q000276:immunology*; D028761:Withholding Treatment
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid