Neurological Sciences

, Volume 29, Issue 1, pp 37–39

Infratentorial progressive multifocal leukoencephalopathy in a patient treated with fludarabine and rituximab

  • Simona Bonavita
  • Renata Conforti
  • Antonio Russo
  • Rosaria Sacco
  • Alessandro Tessitore
  • Antonio Gallo
  • Marida Della Corte
  • Maria Rosaria Monsurrò
  • Gioacchino Tedeschi
Case Report

DOI: 10.1007/s10072-008-0857-x

Cite this article as:
Bonavita, S., Conforti, R., Russo, A. et al. Neurol Sci (2008) 29: 37. doi:10.1007/s10072-008-0857-x
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Abstract

Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating disease of the central nervous system caused by the JC papovavirus, and is a well known complication in patients with lymphoproliferative diseases (LPDs) during chemotherapy. We report the case of a 59-year-old woman affected by B-cell LPD who underwent three cycles of chemotherapy with fludarabine and rituximab and developed atypical PML six months after the last cycle of chemotherapy. Our patient showed the following peculiarities: chemotherapy regimen was neither heavy nor prolonged; the onset of neurological symptoms was unexpectedly late; the MRI lesion was atypical for non-HIV-related PML, being monofocal and infratentorial with early gadolinium (Gd) enhancement and mass effect; survival was rather prolonged despite the lack of treatment. These data suggest that in patients with LPDs, the occurrence of progressive neurological deficits should induce the suspicion of PML even when clinical onset is late (with respect to chemotherapy) and in the presence of a single infratentorial lesion, with Gd enhancement and mass effect.

Keywords

Progressive multifocal leukoencephalopathy Fludarabine Rituximab Lymphoproliferative disorders 

Copyright information

© Springer-Verlag Italia 2008

Authors and Affiliations

  • Simona Bonavita
    • 1
    • 3
  • Renata Conforti
    • 2
  • Antonio Russo
    • 1
  • Rosaria Sacco
    • 1
  • Alessandro Tessitore
    • 1
  • Antonio Gallo
    • 1
  • Marida Della Corte
    • 1
  • Maria Rosaria Monsurrò
    • 1
  • Gioacchino Tedeschi
    • 1
    • 3
  1. 1.Department of Neurological SciencesII University of NaplesNaplesItaly
  2. 2.Neuroradiology ServiceII University of NaplesNaplesItaly
  3. 3.Institute “Hermitage Capodimonte”NaplesItaly

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