title: Progressive multifocal leukoencephalopathy in a patient with chronic lymphocytic leukaemia treated with alemtuzumab.
abstract: A 69-year-old Caucasian woman with a 15-year history of refractory chronic lymphocytic B-cell leukaemia (CLL), treated with alemtuzumab in the past 10 months presented with a subacute right foot drop. Initial evaluation with a brain CT scan, lumbosacral MRI, nerve conduction studies and LP was negative. In the following months, progressive right hemibody weakness and dysarthria developed. Brain MRI showed a bilateral parasagittal frontal lesion. Alemtuzumab treatment was withdrawn. Progressive multifocal leukoencephalopathy (PML) was confirmed by PCR. Attempted antiviral therapies proved fruitless. Inexorable clinical deterioration ensued and the patient passed away 10 months after the presentation. This case report intends to call attention for PML as a potential fatal complication of severe immunosuppression, including the possible role of new monoclonal antibodies (such as alemtuzumab) in its pathogenesis.
authors.affiliation: Department of Neurology, Coimbra Hospital and University Centre, Coimbra, Portugal.
authors.forename: Luís
authors.initials: L
authors.lastname: Isidoro
authors.forename: Paula
authors.initials: P
authors.lastname: Pires
authors.forename: Luís
authors.initials: L
authors.lastname: Rito
authors.forename: Gustavo
authors.initials: G
authors.lastname: Cordeiro
mesh_terms: D000368:Aged; D000074323:Alemtuzumab; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects* / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D017809:Fatal Outcome; D005260:Female; D005625:Frontal Lobe / Q000473:pathology; D020233:Gait Disorders, Neurologic / Q000139:chemically induced / Q000175:diagnosis; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy*; D007968:Leukoencephalopathy, Progressive Multifocal / Q000139:chemically induced* / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D009894:Opportunistic Infections / Q000139:chemically induced* / Q000175:diagnosis*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000074323:Alemtuzumab