title: Progressive multifocal leukoencephalopathy in a patient treated with etanercept.
abstract: BACKGROUND
  Recently, increased attention has been paid to the association of progressive multifocal leukoencephalopathy (PML) with the use of immunomodulatory medications for autoimmune diseases.
  
  
  METHODS
  A 23-year-old Native American woman with a history of systemic lupus erythematosus and erosive polyarthritis treated with prednisone and etanercept presented with focal weakness, hemiataxia, diplopia, and dysarthria. Brain magnetic resonance imaging demonstrated progressive, T2 signal hyperintensities within the brainstem and cerebellar white matter without mass effect or gadolinium enhancement. Cerebrospinal fluid showed elevated protein and JC virus polymerase chain reaction positive with 28,600 copies/ml diagnostic of PML.
  
  
  CONCLUSIONS
  The development of PML in this patient treated with etanercept and prednisone highlights the increased risk for opportunistic infection with JC virus in patients with autoimmune diseases on immunosuppressive therapies.
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Graff-Radford
authors.forename: Maisha T
authors.initials: MT
authors.lastname: Robinson
authors.forename: Rahma M
authors.initials: RM
authors.lastname: Warsame
authors.forename: Eric L
authors.initials: EL
authors.lastname: Matteson
authors.forename: Scott D Z
authors.initials: SD
authors.lastname: Eggers
authors.forename: B Mark
authors.initials: BM
authors.lastname: Keegan
mesh_terms: D004359:Drug Therapy, Combination / Q000009:adverse effects; D000068800:Etanercept; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007074:Immunoglobulin G / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007968:Leukoencephalopathy, Progressive Multifocal / Q000139:chemically induced* / Q000821:virology; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy*; D011241:Prednisone / Q000009:adverse effects; D018124:Receptors, Tumor Necrosis Factor; D055815:Young Adult
chemical_list: D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept; D011241:Prednisone