| Progressive multifocal leukoencephalopathy associated with mycophenolate mofetil treatment in a woman with lupus and CD4+ T-lymphocyte deficiency. | |
| | |
MedLine Citation:
|
PMID: 21976399 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
There is an increase in the number of patients with systemic lupus erythematosus (SLE) reported as developing progressive multifocal leukoencephalopathy (PML) while on intensive immunosuppressive therapy. A 39-year-old HIV-negative woman with a 10-year history of SLE presented with progressive left-side weakness while on maintenance therapy with oral prednisone and mycophenolate mofetil (MMF). On several occasions low CD4+ T-lymphocyte counts were found (68/µL). Brain magnetic resonance imaging (MRI) revealed a large lesion in the right subcortical fronto-parietal region and a smaller one in the left frontal subcortex, corresponding to the PML. In cerebrospinal fluid, polymerase chain reaction (PCR) for JC virus (JCV) was negative, but anti-JCV antibodies were highly positive. Diagnosis of probable PML was made and MMF was withdrawn. The patient's condition improved with marked reduction of left-side weakness and an increase in CD4(+) T-lymphocyte count (141/µL). Follow-up MRI showed regression of lesions and over the next 6 months the patient remained stable. In spite of the grave prognosis associated with PML, SLE patients can have an excellent outcome if immunosuppressants are discontinued as soon as the correct diagnosis is made. SLE patients with associated low CD4(+) T-lymphocyte counts should be monitored for the development of PML during immunosuppressive therapy in particular. |
| | |
Authors:
|
A M Pavlovic; B Bonaci-Nikolic; D Kozic; J Ostojic; M Abinun; T Svabic-Medjedovic; M Nikolic; N Sternic |
Related Documents
:
|
20562399 - Somatosensory cortical remodelling after rehabilitation and clinical benefit of in writ... 9277029 - Pattern-reversal visual evoked potentials in migraineurs with or without visual aura. 20146069 - Slow saccades in bulbar-onset motor neurone disease. 20453409 - Clinical study of the responsible lesion for dysarthria in the cerebellum. 3267489 - Abnormalities of visual evoked responses in hyperprolactinaemia. 9285449 - Assessment of olfaction in multiple sclerosis: evidence of dysfunction by olfactory evo... 22592419 - C4d as a diagnostic tool in membranous nephropathy. 1977979 - Coagulation factor abnormalities as possible thrombotic risk factors after fontan opera... 10022459 - Reduced 11beta-hydroxysteroid dehydrogenase activity in patients with the nephrotic syn... |
Publication Detail:
|
Type: Case Reports; Journal Article; Research Support, Non-U.S. Gov't Date: 2011-10-05 |
Journal Detail:
|
Title: Lupus Volume: 21 ISSN: 1477-0962 ISO Abbreviation: Lupus Publication Date: 2012 Jan |
Date Detail:
|
Created Date: 2011-12-15 Completed Date: 2012-04-24 Revised Date: 2013-03-21 |
Medline Journal Info:
|
Nlm Unique ID: 9204265 Medline TA: Lupus Country: England |
Other Details:
|
Languages: eng Pagination: 100-2 Citation Subset: IM |
Affiliation:
|
Clinic for Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia. aleksandrapavlovic@hotmail.com |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adult CD4 Lymphocyte Count* CD4-Positive T-Lymphocytes / cytology*, metabolism* Female Humans Immunosuppressive Agents / adverse effects* JC Virus / physiology Leukoencephalopathy, Progressive Multifocal / chemically induced*, pathology, virology Lupus Erythematosus, Systemic / complications, drug therapy* Magnetic Resonance Imaging Mycophenolic Acid / adverse effects, analogs & derivatives* Virus Activation |
| Chemical | |
Reg. No./Substance:
|
0/Immunosuppressive Agents; 128794-94-5/mycophenolate mofetil; 24280-93-1/Mycophenolic Acid |
| Comments/Corrections | |
Comment In:
|
Z Rheumatol. 2013 Feb;72(1):5 |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Efficacy and safety of enteric-coated mycophenolate sodium in combination with two glucocorticoid re...
Next Document: Aggravated capillary non-perfusion after intravitreal bevacizumab for macular edema secondary to sys...