Fatal progressive multifocal leukoencephalopathy in a patient with non-Hodgkin lymphoma treated with rituximab.
We report a case of progressive multifocal leukoencephalopathy (PML) in a woman with non-Hodgkin lymphoma treated with chemotherapy in combination with rituximab. She presented with rapid deterioration of vision and subsequently cognitive decline. Magnetic resonance imaging (MRI) of the brain raised the suspicion of PML. The first PCR analysis of the cerebrospinal fluid (CSF) was negative, but a second sample was positive for JC virus DNA. Anti-viral treatment was ineffective and the patient died 7 months after debut of symptoms. Our case emphasizes the importance of the awareness of PML in patients with progressive neurological symptoms treated with antilymphocytic drugs and that consecutive CSF analyses may be needed to detect the JC virus.
Paues
Jakob
J
Division for Infectious Diseases, Department for Clinical and Experimental Medicine, Faculty of Health Sciences, 581 85 Linköping, Sweden. jakob.paues@liu.se
Vrethem
Magnus
M
D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D002555:Cerebrospinal Fluid / Q000821:virology; D054697:Cytostatic Agents / Q000627:therapeutic use*; D004279:DNA, Viral / Q000134:cerebrospinal fluid; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007577:JC Virus / Q000302:isolation & purification; D007968:Leukoencephalopathy, Progressive Multifocal / Q000175:diagnosis*; D008228:Lymphoma, Non-Hodgkin / Q000150:complications* / Q000188:drug therapy*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D011859:Radiography; D000069283:Rituximab
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D054697:Cytostatic Agents; D004279:DNA, Viral; D007155:Immunologic Factors; D000069283:Rituximab