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Improvement of progressive multifocal leukoencephalopathy after cidofovir therapy in a patient with a destructive

J F Viallard1, E Lazaro, E Ellie

  • 1Service de Médecine Interne et Maladies Infectieuses, Hôpital Haut-Lévêque, 5, avenue de Magellan, Pessac Cedex, France. jean-francois.viallard@chu-bordeaux.fr

Infection
|February 14, 2007
PubMed

Insights

Progressive multifocal leukoencephalopathy (PML), a brain disease caused by JC virus (JCV), can occur in patients with autoimmune diseases. Treatment with cidofovir improved neurological symptoms in a patient with anti-JO1 antibody-associated polyarthritis.

Area of Science:

  • Neurovirology
  • Rheumatology
  • Neurology

Background:

  • JC virus (JCV) causes progressive multifocal leukoencephalopathy (PML), a severe demyelinating brain disease.
  • PML is often refractory to treatment and associated with significant morbidity and mortality.
  • Systemic rheumatic diseases, particularly those treated with immunosuppressants, may increase PML risk.

Observation:

  • A 67-year-old woman with anti-JO1 antibody-associated polyarthritis and corticosteroid treatment developed PML.
  • Neurological symptoms persisted despite ongoing glucocorticoid therapy.
  • Central nervous system imaging revealed white matter changes suggestive of PML.

Findings:

  • Administration of cidofovir led to neurological improvement in the patient.
  • This case highlights the potential for JCV to manifest in the context of systemic rheumatic diseases.
  • The use of immunosuppressive agents in rheumatic disease patients warrants vigilance for PML.

Implications:

  • JC virus (JCV) should be considered in the differential diagnosis of neurological symptoms in patients with rheumatic diseases, especially those on immunosuppressants.
  • Early detection and treatment of PML may improve patient outcomes.
  • This case underscores the importance of considering neurotropic viral infections in immunocompromised patients with neurological deficits.

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