title: Rituximab-associated progressive multifocal leukoencephalopathy.
abstract: The definition "Progressive Multifocal Leukoencephalopathy" (PML) was first used in 1958 to describe a fatal demyelinating central nervous system (CNS) disease in patients with lymphoproliferative disorders. In 1971, the virus responsible for the disease was isolated and named John Cunningham virus (JCV). We present a rare case of a 62-year-old male with chronic lymphocytic leukemia and PML. In our work, we discuss the diagnostic and therapeutic challenges and offer suggestions for preventing PML development. The main learning points are: 1. Regularly check the level of immunoglobulins and the CD4+ : CD8+ T-cell ratio, intravenous administration of immunoglobulins should be considered when recording their reduction. 2. In checking the CD4+ : CD8+ T-cell ratio and verifying the impossibility of raising the level of immunoglobulins, we must weigh the possible benefits of continuing treatment with monoclonal antibody against the risks. 3. Physicians should maintain a high index of suspicion for the development of PML in patients under treatment with monoclonal antibodies, especially when there is a new development of neurological signs or symptoms.Key words: JC virus - progressive multifocal leukoencephalopathy - recommendation - rituximab.
authors.forename: Juraj
authors.initials: J
authors.lastname: Sokol
authors.forename: Lenka
authors.initials: L
authors.lastname: Lisá
authors.forename: Jana
authors.initials: J
authors.lastname: Zeleňáková
authors.forename: Tomáš
authors.initials: T
authors.lastname: Balhárek
authors.forename: Ivana
authors.initials: I
authors.lastname: Plameňová
authors.forename: Ján
authors.initials: J
authors.lastname: Staško
authors.forename: Peter
authors.initials: P
authors.lastname: Kubisz
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001921:Brain / Q000000981:diagnostic imaging*; D003520:Cyclophosphamide / Q000008:administration & dosage; D006801:Humans; D016867:Immunocompromised Host / Q000276:immunology; D007577:JC Virus; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy*; D007968:Leukoencephalopathy, Progressive Multifocal / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage; D000069283:Rituximab / Q000009:adverse effects*; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D000970:Antineoplastic Agents; D000069283:Rituximab; D014750:Vincristine; D003520:Cyclophosphamide; D011241:Prednisone