title: Posterior reversible encephalopathy syndrome masquerading as progressive multifocal leukoencephalopathy in rituximab treated neuromyelitis optica.
abstract: Both progressive multifocal leukoencephalopathy (PML) and posterior reversible encephalopathy syndrome (PRES) have been reported as complications of rituximab therapy. These disorders may appear indistinguishable on magnetic resonance imaging (MRI). We report on a 42 year old woman with neuromyelitis optica (NMO) of 10 years duration who developed extensive white matter disease affecting chiefly both parietal lobes 6 months after her first and only dose of rituximab. The MRI findings suggested the diagnosis of PML, but her history was more consistent with PRES. Ultimately, a brain biopsy was performed which was consistent with the diagnosis of PRES. PRES and PML may have overlapping symptomatology and be indistinguishable on MRI. An approach to distinguishing between these two disorders is addressed.
authors.affiliation: Departments of Neurology and Pathology, University of Kentucky College of Medicine, Lexington, KY 40536-0284, United States. Electronic address: joseph.berger@uphs.upenn.edu.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Berger
authors.affiliation: Departments of Neurology and Pathology, University of Kentucky College of Medicine, Lexington, KY 40536-0284, United States.
authors.forename: Janna
authors.initials: J
authors.lastname: Neltner
authors.affiliation: Departments of Neurology and Pathology, University of Kentucky College of Medicine, Lexington, KY 40536-0284, United States.
authors.forename: Charles
authors.initials: C
authors.lastname: Smith
authors.affiliation: Departments of Neurology and Pathology, University of Kentucky College of Medicine, Lexington, KY 40536-0284, United States.
authors.forename: Franca
authors.initials: F
authors.lastname: Cambi
mesh_terms: D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects* / Q000627:therapeutic use; D001921:Brain / Q000187:drug effects / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects* / Q000627:therapeutic use; D007968:Leukoencephalopathy, Progressive Multifocal / Q000175:diagnosis* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D009471:Neuromyelitis Optica / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D054038:Posterior Leukoencephalopathy Syndrome / Q000139:chemically induced* / Q000175:diagnosis* / Q000473:pathology; D000069283:Rituximab
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab
keywords: JC virus; Neuromyelitis optica; Posterior reversible encephalopathy syndrome; Progressive multifocal leukoencephalopathy; Rituximab