title: JC polyomavirus granule cell neuronopathy in a patient treated with rituximab.
abstract: OBJECTIVE
  Progressive multifocal leukoencephalopathy results from lytic infection of the glia by the JC polyomavirus (JCV); JCV granule cell neuronopathy is caused by infection with a mutated form of JCV, leading to a shift in viral tropism from the glia to cerebellar granule cells. This shift results in a clinical syndrome dominated by progressive cerebellar dysfunction that might elude standard diagnostic workup strategies for ataxia.
  
  
  METHODS
  We present the case report of a patient receiving long-term rituximab therapy who developed progressive cerebellar ataxia and marked isolated cerebellar degeneration. This syndrome resulted from JCV granule cell neuronopathy associated with a novel JCV mutation.
  
  
  CONCLUSIONS
  New onset or worsening of isolated cerebellar ataxia in patients being treated with rituximab or natalizumab warrants early assessment for JCV infection.
authors: Department of Neurology, University of Michigan, Ann Arbor.
authors: Louis
authors: L
authors: Dang
authors: Division of Neurovirology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors: Xin
authors: X
authors: Dang
authors: Division of Neurovirology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors: Igor J
authors: IJ
authors: Koralnik
authors: Department of Neurology, University of Michigan, Ann Arbor.
authors: Peter K
authors: PK
authors: Todd
mesh_terms: D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects* / Q000627:therapeutic use; D002524:Cerebellar Ataxia / Q000134:cerebrospinal fluid / Q000473:pathology* / Q000821:virology*; D003594:Cytoplasmic Granules / Q000473:pathology / Q000821:virology; D020233:Gait Disorders, Neurologic / Q000473:pathology / Q000628:therapy / Q000821:virology; D006801:Humans; D007577:JC Virus / Q000235:genetics / Q000302:isolation & purification; D007968:Leukoencephalopathy, Progressive Multifocal / Q000473:pathology* / Q000628:therapy / Q000821:virology*; D008297:Male; D000069283:Rituximab; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab