Vnitr Lek 2017, 63(1):60-64 | DOI: 10.36290/vnl.2017.012

Rituximab-associated progressive multifocal leukoencephalopathy

Juraj Sokol^1,*, Lenka Lisá¹, Jana Zeleňáková², Tomáš Balhárek³, Ivana Plameňová¹, Ján Staško¹, Peter Kubisz¹

¹ Department of Haematology and Transfusion Medicine, National Centre of Haemostasis and Thrombosis, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovakia

² Department of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovakia

³ Department of Pathological Anatomy, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Slovakia

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.

Keywords: JC virus; progressive multifocal leukoencephalopathy; recommendation; rituximab

Received: March 6, 2016; Accepted: December 13, 2016; Published: January 1, 2017  Show citation