Progressive multifocal leukoencephalopathy (PML) is a rare, often fatal infection of the central nervous system caused by reactivation of John Cunningham virus (JCV). The case of a 59-year-old woman presenting with neurological disorders after treatment of her relapsed lymphoma with rituximab, among others, is reported. Magnetic resonance imaging showed fast-growing white matter lesions of both hemisphere and cerebellar that were neither space-consuming nor enhancing contrast media. Clinical and radiological suspicion of PML was confirmed by detection of JCV-DNA in cerebrospinal fluid. The patient died from devastating neurological decline only 11 days after the diagnosis was made. Due to the wider indication of monoclonal antibodies in almost every medical specialty we must always consider iatrogenic PML in addition to classic PML associated with acquired immunodeficiency syndrome (AIDS).
Eine 59-jährige Patientin entwickelte neurologische Defizite nach vorheriger rituximabhaltiger Lymphomtherapie. Die Konstellation aus Marklagerläsionen ohne Schrankenstörung in Groß- und Kleinhirn und DNA-Nachweis des John Cunningham Virus (JCV) aus Liquor führte zur Diagnose einer progressiven multifokalen Enzephalopathie (PML). Die PML ist eine seltene, aber tödliche Infektion des zentralen Nervensystems hervorgerufen durch eine Reaktivierung des JC-Virus, die nicht nur bei HIV-Infektionen, sondern auch iatrogen nach Einsatz monoklonaler Antikörper auftreten kann.
Keywords: JC virus; Lymphoma; PML; Progressive multifocal leukoencephalopathy; Rituximab.
© 2022. The Author(s).