Effective immune restoration after immunosuppressant discontinuation in a lupus patient presenting progressive multifocal leukoencephalopathy.
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.
Lefèvre
Guillaume
G
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
Queyrel
Viviane
V
Maurage
Claude-Alain
CA
Laurent
Charles
C
Launay
David
D
Lacour
Arnaud
A
Charlanne
Hilaire
H
Morell-Dubois
Sandrine
S
Lambert
Marc
M
Maillard
Hélène
H
Vermersch
Patrick
P
Hachulla
Eric
E
Hatron
Pierre-Yves
PY
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
D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid