title: Failure of mefloquine therapy in progressive multifocal leukoencephalopathy: report of two Japanese patients without human immunodeficiency virus infection.
abstract: Although progressive multifocal leukoencephalopathy (PML) cases showing responses to mefloquine therapy have been reported, the efficacy of mefloquine for PML remains unclear. We report on the failure of mefloquine therapy in two Japanese patients with PML unrelated to human immunodeficiency virus. One of the patients was a 47-year-old male who had been treated with chemotherapy for Waldenström macroglobulinemia, and the other was an 81-year-old male with idiopathic CD4(+) lymphocytopenia. Diagnosis of PML was established based on MRI findings and increased JC virus DNA in the cerebrospinal fluid in both patients. Mefloquine was initiated about 5 months and 2 months after the onset of PML, respectively. During mefloquine therapy, clinical and radiological progression was observed, and JC virus DNA in the cerebrospinal fluid was increased in both patients. Both patients died about 4 months and 2 months after initiation of mefloquine, respectively. Further studies are necessary to clarify the differences between mefloquine responders and non-responders in PML.
authors.affiliation: Department of Neurology, JA Toride Medical Center, Ibaraki, Japan. zen@bg7.so-net.ne.jp
authors.forename: Zen
authors.initials: Z
authors.lastname: Kobayashi
authors.forename: Miho
authors.initials: M
authors.lastname: Akaza
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Numasawa
authors.forename: Shoichiro
authors.initials: S
authors.lastname: Ishihara
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tomimitsu
authors.forename: Kazuo
authors.initials: K
authors.lastname: Nakamichi
authors.forename: Masayuki
authors.initials: M
authors.lastname: Saijo
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Morio
authors.forename: Norio
authors.initials: N
authors.lastname: Shimizu
authors.forename: Nobuo
authors.initials: N
authors.lastname: Sanjo
authors.forename: Shuzo
authors.initials: S
authors.lastname: Shintani
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Mizusawa
mesh_terms: D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D001072:Apraxias / Q000209:etiology; D044466:Asian People; D001921:Brain / Q000473:pathology; D004279:DNA, Viral / Q000235:genetics; D020233:Gait Disorders, Neurologic / Q000209:etiology; D018628:Gene Dosage; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007577:JC Virus; D007968:Leukoencephalopathy, Progressive Multifocal / Q000188:drug therapy* / Q000821:virology; D008279:Magnetic Resonance Imaging; D008297:Male; D015767:Mefloquine / Q000627:therapeutic use*; D008875:Middle Aged; D009120:Muscle Cramp / Q000209:etiology; D010291:Paresis / Q000209:etiology; D000069283:Rituximab; D017211:Treatment Failure
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D004279:DNA, Viral; D007166:Immunosuppressive Agents; D000069283:Rituximab; D015767:Mefloquine