Progressive multifocal leukoencephalopathy

Abstract

Progressive multifocal leukoencephalopathy developed in a patient with rheumatoid arthritis after treatment with an immunosuppressive agent (chlorambucil). We fell that this case lends further support to the concept that an altered immunologic state is important in the appearance of this infection, which is probably viral in origin.

The emergence of progressive multifocal leukoencephalopathy (PML) in rheumatic diseases

“…The non-SLE patients who developed PML were all on immunosuppressive medications and included: two with rheumatoid arthritis (RA) (one with concomitant polymyositis) [43,44], four with Wegener's granulomatosus [45e48] with a fifth case also found [49] on literature review (in German; biopsy proven PML), five with dermatomyositis [50e53], one with polymyositis (in addition to the patient above with RA and polymyositis) [54], and one patient with scleroderma and secondary amyloidosis [55]. The average age of patients with non-SLE related PML was 50, with reported survival of 1e9 months for severe deficits and up to 50 months with more mild deficits in one patient.…”

Progressive multifocal leukoencephalopathy in rheumatic diseases: Evolving clinical and pathologic patterns of disease

“…PML has been described mainly in patients infected with the human immunodeficiency virus (HIV). However, other immunosuppressed patient populations, including those with malignancies, organ transplants, and systemic lupus erythematosus (SLE) (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) and other rheumatic diseases (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32), are at risk of developing this complication.…”

JC Virus Agnoprotein Inhibits In Vitro Differentiation of Oligodendrocytes and Promotes Apoptosis

“…PML manifests clinically with signs of neurological deficits of various degrees, including weakness, visual deficits, and cognitive abnormalities. PML is mainly associated with advanced human immunodeficiency virus (HIV)-induced diseases and AIDS (8,9), lymphoproliferative or myeloproliferative diseases, malignancies, and rheumatic disorders treated with corticosteroids and cytotoxic drugs (1,16,25,34,39,52,58,71,75,77). Recently, PML has also been diagnosed in patients with multiple sclerosis and Crohn's disease receiving natalizumab (37,40,42,74), a humanized monoclonal antibody that binds to the ␣4 subunit of ␣4␤1 and ␣4␤7 integrins and inhibits the trafficking of leukocytes across the blood-brain barrier.…”