Progressive Multifocal Leukoencephalopathy as a Complication of Lymphoma Therapy – a Case Report

Czech version

Authors: M. Vališ ¹; D. Belada ²; R. Taláb ¹; M. Hrudková ²; J. Masopust ³; H. Hornychová ⁴; L. Klzo ⁵; M. Kanta ⁶; J. Malý ²
Authors‘ workplace: LF UK a FN Hradec Králové: 1Ne urologická klinika, 2II. interní klinika, 3Psychi atrická klinika, 4Fingerlandův ústav patologie, 5Radiologická klinika, 6Neurochirurgická klinika
Published in: Cesk Slov Neurol N 2009; 72/105(2): 159-161
Category: Case Report

Overview

We are describing the case of a 69- ye ar- old male pati ent who had been tre ated since the ye ar 2000 for chronic lymphocytic le ukemi a. Initi ally, he was tre ated with cytostatic agents and rituximab. After the third progressi on of the dise ase, the pati ent received fo ur cycles of FCR (Fludarabine, Cyclophosphamide, Rituximab) since May 2006 with the achi evement of complete remissi on. Two months after the completi on of the therapy, the pati ent developed organic psychosyndrome with right- sided hemiparesis. Evalu ati on of the pati ent’s brain using magnetic resonance imaging (MRI) reve aled multiple non‑expanding lesi ons in the white matter in both frontal lobes, non‑opacifying after the administrati on of a contrast agent. Electron microscope examinati on demonstrated JC virus in the cerebrospinal fluid and also in the blo od and urine. Despite antiviral tre atment with high dose of aciclovir, the pati ent’s clinical conditi on progressed into qu adriplegi a during several days. Subsequently the pati ent developed a comatose conditi on with fatal septic shock. Immunohistochemical examinati on of the white matter demonstrated presence of the JC virus and massive demyelinati on. The case was concluded as a rare progressive multifocal le ukoencephalopathy in an immunocompromised pati ent tre ated for a lymphoproliferative dise ase.

Key words:
progressive multifocal le ukoencephalopathy – immunosuppressi on – rituximab – JC virus – lymphoproliferative disorders

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