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Determining Immune System Suppression versus CNS Protection for Pharmacological Interventions in Autoimmune Demyelination
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Determining Immune System Suppression versus CNS Protection for Pharmacological Interventions in Autoimmune Demyelination

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The Risk of Progressive Multifocal Leukoencephalopathy in the Biologic Era: Prevention and Management

Eamonn S Molloy1, Cassandra M Calabrese2, Leonard H Calabrese2

  • 1Department of Rheumatology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.

Rheumatic Diseases Clinics of North America
|November 29, 2016
PubMed

Insights

Progressive multifocal leukoencephalopathy (PML), a rare CNS infection, can mimic rheumatic diseases. Early diagnosis and immune restoration are crucial for improving the poor prognosis of PML in immunosuppressed patients.

Area of Science:

  • Neuroimmunology
  • Infectious Diseases
  • Rheumatology

Background:

  • Progressive multifocal leukoencephalopathy (PML) is a rare, fatal demyelinating CNS infection.
  • Caused by John Cunningham virus reactivation in immunosuppressed individuals.
  • PML presents with increasing clinical heterogeneity.

Purpose of the Study:

  • To highlight the importance of considering PML in the differential diagnosis of rheumatic diseases.
  • To emphasize the need for increased rheumatologist awareness of PML.
  • To underscore the impact of early diagnosis and immune restoration on PML prognosis.

Main Methods:

  • Review of clinical presentations and diagnostic considerations for PML.
  • Analysis of PML's relevance in the context of rheumatic diseases.
  • Discussion of therapeutic implications and prognostic factors.

Main Results:

  • PML can present with neurologic symptoms that overlap with rheumatic conditions.
  • Earlier identification of PML may lead to timely intervention.
  • Restoration of immune function is a key factor in managing PML.

Conclusions:

  • PML should be included in the differential diagnosis for neurologic manifestations in rheumatic disease patients.
  • Enhanced awareness among rheumatologists can facilitate earlier PML diagnosis.
  • Prompt diagnosis and treatment can potentially improve outcomes for PML patients.
Keywords:
Autoimmune rheumatic diseasesBiologic therapyProgressive multifocal leukoencephalopathyRituximabSynthetic immunosuppressive therapySystemic lupus erythematosus

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