title: Progressive multifocal leukoencephalopathy in a heart transplant recipient following rituximab therapy for antibody-mediated rejection.
abstract: We report the case of a male heart transplant recipient who developed acute antibody-mediated rejection and was treated with 5 weeks of a rituximab-containing regimen. Two months later he presented with progressive motor and cognitive impairments and was diagnosed with progressive multifocal leukoencephalopathy (PML). He was treated with reduction of his immunosuppressive medications, mirtazapine, IVIG and plasmapheresis. He died within weeks. We reviewed the current literature on PML and its association with immunosuppression, highlighting its impact in the setting of solid organ transplantation and considering the potential effect of newer biologic drugs on the incidence of this devastating disease in the transplant population.
authors.affiliation: Section of Advanced Heart Failure and Transplantation, University of Alabama at Birmingham, AL.
authors.forename: R Y
authors.initials: RY
authors.lastname: Loyaga-Rendon
authors.affiliation: Section of Advanced Heart Failure and Transplantation, Cleveland Clinic Foundation.
authors.forename: D O
authors.initials: DO
authors.lastname: Taylor
authors.affiliation: Department of Infectious Diseases, Cleveland Clinic Foundation, OH.
authors.forename: C E
authors.initials: CE
authors.lastname: Koval
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000150:complications; D017809:Fatal Outcome; D006084:Graft Rejection / Q000628:therapy*; D006333:Heart Failure / Q000150:complications* / Q000628:therapy*; D016027:Heart Transplantation; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007968:Leukoencephalopathy, Progressive Multifocal / Q000150:complications* / Q000175:diagnosis*; D008297:Male; D008803:Mianserin / Q000031:analogs & derivatives / Q000627:therapeutic use; D008875:Middle Aged; D000078785:Mirtazapine; D010956:Plasmapheresis; D000069283:Rituximab
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D016756:Immunoglobulins, Intravenous; D007166:Immunosuppressive Agents; D008803:Mianserin; D000069283:Rituximab; D000078785:Mirtazapine