Posterior Fossa Progressive Multifocal Leukoencephalopathy Secondary to Rituximab

Mounika Guduru; Venkata Sunil Bendi; Mariana S Bebawy; Dinesh Bande; Abhishek Matta

doi:10.7759/cureus.10888

Posterior Fossa Progressive Multifocal Leukoencephalopathy Secondary to Rituximab

Cureus. 2020 Oct 10;12(10):e10888. doi: 10.7759/cureus.10888.

Authors

Mounika Guduru¹, Venkata Sunil Bendi², Mariana S Bebawy³, Dinesh Bande⁴, Abhishek Matta⁴

Affiliations

¹ Radiology, Creighton University Medical Center, Omaha, USA.
² Neurology, Creighton University Medical Center, Omaha, USA.
³ Family Medicine, Creighton University Medical Center, Omaha, USA.
⁴ Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Fargo, USA.

Abstract

Progressive multifocal leukoencephalopathy (PML) is a rare fatal central nervous system disorder characterized by infection-induced demyelination of white matter due to the opportunistic reactivation of John Cunningham virus in an immunocompromised patient. PML is associated with many immune-mediated diseases, lymphoproliferative conditions, and immunosuppressive agents. In this case report, we present a 79-year-old female patient diagnosed with rheumatoid arthritis who developed posterior fossa PML while on rituximab. She presented with subacute cerebellar ataxia, dysarthria, and nystagmus, and her brain MRI showed right pontine and pontocerebellar lesion with diffusion restriction and heterogenous enhancement highly characteristic of PML. Though many cases of PML with rituximab were reported in the literature, our case describes a rare type of PML affecting the posterior fossa in an HIV-negative patient on rituximab.

Keywords: pml; posterior fossa; progressive multifocal leukoencephalopathy; rheumatoid arthritis; rituximab.

Publication types

Case Reports