title: Progressive Multifocal Leukoencephalopathy Following Treatment with Rituximab in an HIV-Negative Patient with Non-Hodgkin Lymphoma. A Case Report and Literature Review.
abstract: Progressive multifocal leukoencephalopathy (PML) is a rare rapidly progressive demyelinating disease of the central nervous system caused by reactivation of latent John Cunningham (JC) polyomavirus (JCV) infection. We describe an unusual case of PML in a 54-year-old patient with follicular non-Hodgkin lymphoma who received rituximab plus cyclophosphamide, hydroxydaunorubicin, oncovicin and prednisolone (R-CHOP) therapy. She started to notice gradual progressive neurological symptoms about two months after completion of rituximab treatment and was therefore admitted to hospital. On admission, brain CT and MRI showed widespread lesions consistent with a demyelinating process involving the subcortical and deep white matter of the cerebral and cerebellar hemispheres. CT and MRI findings were suggestive of PML, and JC virus DNA was detected by polymerase chain reaction assay of the cerebrospinal fluid and serum. The patient was treated supportively but reported a progressive worsening of the clinical and radiological findings. Our report emphasizes the role of CT and MRI findings in the diagnosis of PML and suggests that PML should be considered in patients with progressive neurological disorders involving the entire nervous system and mainly the white matter, especially in the presence of previous immunomodulatory treatment or immunosuppression.
authors.affiliation: Division of Radiology, Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, San Salvatore Hospital of L'Aquila; L'Aquila, Italy - alessiacat@tiscali.it.
authors.forename: Valentina
authors.initials: V
authors.lastname: Felli
authors.affiliation: Division of Radiology, Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, San Salvatore Hospital of L'Aquila; L'Aquila, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Di Sibio
authors.affiliation: Division of Radiology, Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, San Salvatore Hospital of L'Aquila; L'Aquila, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Anselmi
authors.affiliation: Division of Radiology, Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, San Salvatore Hospital of L'Aquila; L'Aquila, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Gennarelli
authors.affiliation: Division of Neurology, Department of Life, Health and Environmental Sciences, University of L'Aquila, San Salvatore Hospital of L'Aquila; L'Aquila, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Sucapane
authors.affiliation: Division of Neuroradiology, Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, San Salvatore Hospital of L'Aquila; L'Aquila, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Splendiani
authors.affiliation: Division of Neuroradiology, Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, San Salvatore Hospital of L'Aquila; L'Aquila, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Catalucci
authors.affiliation: Division of Neurology, Department of Life, Health and Environmental Sciences, University of L'Aquila, San Salvatore Hospital of L'Aquila; L'Aquila, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Marini
authors.affiliation: Division of Neuroradiology, Department of Biotechnology and Applied Clinical Sciences, University of L'Aquila, San Salvatore Hospital of L'Aquila; L'Aquila, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Gallucci
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D001921:Brain / Q000000981:diagnostic imaging* / Q000473:pathology; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use; D004317:Doxorubicin / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007968:Leukoencephalopathy, Progressive Multifocal / Q000139:chemically induced* / Q000000981:diagnostic imaging* / Q000473:pathology; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use; D000069283:Rituximab / Q000009:adverse effects* / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D014750:Vincristine / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone
keywords: JC virus; follicular non-Hodgkin lymphoma; progressive multifocal leukoencephalopathy; rituximab