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Progressive multifocal leukoencephalopathy-remission with cytarabine
T O'Riordan1, P A Daly, M Hutchinson
1Department of Clinical Haematology/Oncology, St James's Hospital, Dublin, Ireland.
Insights
A patient with non-Hodgkin's lymphoma developed progressive multifocal leukoencephalopathy (PML). Intrathecal cytarabine treatment led to remission of both PML and lymphoma.
Area of Science:
- Neuroscience
- Oncology
- Virology
Background:
- Non-Hodgkin's lymphoma survivors are at risk for opportunistic infections.
- Progressive multifocal leukoencephalopathy (PML) is a rare, severe demyelinating disease caused by JC polyomavirus.
Observation:
- A 51-year-old woman in remission from non-Hodgkin's lymphoma presented with rapidly progressive dementia.
- Diagnosis of PML was confirmed by elevated JC polyomavirus antibody titers and MRI findings.
Findings:
- Initial treatment with intravenous cytarabine yielded minimal improvement.
- Intrathecal cytarabine administration resulted in rapid clinical improvement and remission.
Implications:
- Intrathecal cytarabine is a potential therapeutic option for PML in immunocompromised patients.
- This case highlights the importance of considering PML in patients with neurological decline post-lymphoma treatment.
- Successful dual remission suggests a potential synergistic effect or improved drug delivery with intrathecal administration.
Abstract:
A 51-year-old woman who was in complete remission from non-Hodgkin's lymphoma, developed a rapidly progressive dementia. Progressive multifocal leukoencephalopathy (PML) was diagnosed on the basis of a rising antibody titre to JC polyomavirus in cerebro-spinal fluid and serum and the presence of diffuse white matter changes on magnetic resonance imaging. She was treated initially with intravenous cytarabine and showed minimal improvement. Rapid improvement occurred when intrathecal cytarabine was added and the patient is in complete remission from both lymphoma and PML 20 months later.