title: Mefloquine improved progressive multifocal leukoencephalopathy in a patient with immunoglobulin A nephropathy.
abstract: We describe a patient with immunoglobulin A nephropathy who was diagnosed with progressive multifocal leukoencephalopathy (PML) and successfully treated with mefloquine, an antimalarial medication. A 67-year-old man with immunoglobulin A nephropathy presented to the hospital emergency room with fever and generalized tonic-clonic seizure. Cerebrospinal fluid (CSF) nested polymerase chain reaction (PCR) was positive for John Cunningham virus and brain MRI displayed high signal intensity in the white matter in the right parietal lobe without gadolinium enhancement. Tapering of prednisone did not arrest the disease progression and a new lesion was detected on the cerebellum. Administration of mefloquine stopped lesion progression and resulted in dramatic clinical improvement. The CSF nested PCR for the John Cunningham virus also became negative. In reviewing the literature, mefloquine has had a heterogeneous effect in PML patients, and P-glycoprotein polymorphism and proper dosage could contribute to the various effects seen. Mefloquine may be a favorable treatment option in some patients with PML, and P-glycoprotein polymorphism may play an important role in its efficacy. More large studies in other ethnic groups including polymorphism studies for the gene encoding P-glycoprotein (ABCB1/MDR1) and taking into account various underlying conditions with secondary immunosuppression should be carried out to investigate whether mefloquine is effective for treating PML.
authors.affiliation: Department of Neurology, Seoul National University Hospital, 101 Daehang-no, Chongro-gu, Seoul 110-744, South Korea.
authors.forename: Jung-Won
authors.initials: JW
authors.lastname: Shin
authors.affiliation: Department of Neurology, Seoul National University Hospital, 101 Daehang-no, Chongro-gu, Seoul 110-744, South Korea.
authors.forename: Keun-Hwa
authors.initials: KH
authors.lastname: Jung
authors.affiliation: Department of Neurology, Seoul National University Hospital, 101 Daehang-no, Chongro-gu, Seoul 110-744, South Korea.
authors.forename: Soon-Tae
authors.initials: ST
authors.lastname: Lee
authors.affiliation: Department of Neurology, Seoul National University Hospital, 101 Daehang-no, Chongro-gu, Seoul 110-744, South Korea.
authors.forename: Jangsup
authors.initials: J
authors.lastname: Moon
authors.affiliation: Department of Neurology, Seoul National University Hospital, 101 Daehang-no, Chongro-gu, Seoul 110-744, South Korea.
authors.forename: Jung-Ah
authors.initials: JA
authors.lastname: Lim
authors.affiliation: Department of Neurology, Seoul National University Hospital, 101 Daehang-no, Chongro-gu, Seoul 110-744, South Korea.
authors.forename: Jung-Ick
authors.initials: JI
authors.lastname: Byun
authors.affiliation: Department of Neurology, Seoul Paik Hospital, Inje University College of Medicine, Seoul, South Korea.
authors.forename: Kyung-Il
authors.initials: KI
authors.lastname: Park
authors.affiliation: Department of Neurology, Seoul National University Hospital, 101 Daehang-no, Chongro-gu, Seoul 110-744, South Korea.
authors.forename: Sang Kun
authors.initials: SK
authors.lastname: Lee
authors.affiliation: Department of Neurology, Seoul National University Hospital, 101 Daehang-no, Chongro-gu, Seoul 110-744, South Korea. Electronic address: stemcell.snu@gmail.com.
authors.forename: Kon
authors.initials: K
authors.lastname: Chu
mesh_terms: D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D001921:Brain / Q000187:drug effects / Q000473:pathology; D005922:Glomerulonephritis, IGA / Q000150:complications* / Q000473:pathology; D006801:Humans; D007968:Leukoencephalopathy, Progressive Multifocal / Q000150:complications* / Q000188:drug therapy* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D015767:Mefloquine / Q000627:therapeutic use*
chemical_list: D000998:Antiviral Agents; D015767:Mefloquine
keywords: IgA nephropathy; Mefloquine; Progressive multifocal leukoencephalopathy