Progressive multifocal leukoencephalopathy associated with infliximab.

Area of Science:

• Neuroimmunology
• Rheumatology
• Infectious Diseases

Background:

• Rheumatoid arthritis (RA) is a chronic autoimmune disease.
• Biologic therapies like infliximab target inflammatory pathways in RA.
• Progressive multifocal leukoencephalopathy (PML) is a rare, serious demyelinating disease.

Observation:

• A 69-year-old female with seropositive RA experienced cognitive decline after infliximab and methotrexate treatment.
• Cranial MRI revealed demyelinating white matter abnormalities in the frontal and temporal lobes.
• Brain biopsy confirmed histological changes of PML.

Findings:

• Cerebrospinal fluid PCR for JC virus was negative.
• Brain tissue PCR for JC virus was positive.
• The findings suggest a link between infliximab therapy and PML development in this RA patient.

Implications:

• This case underscores the importance of monitoring for opportunistic infections, including PML, in RA patients treated with immunosuppressive biologics.
• It highlights a potential risk associated with infliximab, particularly in patients with autoimmune conditions.
• Further research may be warranted to elucidate the precise mechanisms and risk factors for PML in this context.