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[Rapid-progressive decrease of cognitive and physical functions in a B-cell non-Hodgkin's lymphoma patient treated
A Küllmer1, G Herrmann, B Riecken
1Klinik für Innere Medizin, Gastroenterologie, Hämato-Onkologie, Infektiologie und Diabetologie, Ludwigsburg. armin.kuellmer@kliniken-lb.de
Deutsche Medizinische Wochenschrift (1946)
|June 14, 2013
Summary
A patient with Richter's syndrome developed progressive multifocal leukoencephalopathy (PML) during rituximab and bendamustine treatment. Neurological symptoms during rituximab therapy warrant investigation for PML.
Area of Science:
- Oncology
- Neurology
- Hematology
Background:
- Richter's syndrome, a transformation of chronic lymphocytic leukemia (CLL) to diffuse large B-cell lymphoma, presents complex treatment challenges.
- Rituximab and bendamustine chemotherapy is a standard treatment for Richter's syndrome.
Observation:
- A 71-year-old male with Richter's syndrome experienced neurological decline after rituximab/bendamustine treatment.
- Initial assessment revealed confusion, cognitive impairment, and reactive depression, with no significant findings on brain CT.
- Further investigation, including MRI and lumbar puncture, confirmed progressive multifocal leukoencephalopathy (PML).
Findings:
- Progressive multifocal leukoencephalopathy (PML) was diagnosed in a patient undergoing rituximab and bendamustine therapy for Richter's syndrome.
- The patient's neurological and psychiatric symptoms were indicative of PML, a rare but serious complication.
Implications:
- Clinicians should consider PML in patients developing neurological or psychiatric symptoms during rituximab therapy.
- Prompt diagnosis and cessation of chemotherapy are crucial for managing PML in this patient population.
- This case highlights the importance of vigilance for opportunistic infections like PML in immunocompromised patients undergoing chemotherapy.