Rituximab-associated Progressive Multifocal Leukoencephalopathy Derived from Non-Hodgkin Lymphoma: Neuropathological Findings and Results of Mefloquine Treatment

Yasuteru Sano; Yuta Nakano; Masatoshi Omoto; Masaki Takao; Eiji Ikeda; Atsunori Oga; Kazuo Nakamichi; Masayuki Saijo; Takashi Maoka; Hironori Sano; Motoharu Kawai; Takashi Kanda

doi:10.2169/internalmedicine.54.2308

CASE REPORTS

Rituximab-associated Progressive Multifocal Leukoencephalopathy Derived from Non-Hodgkin Lymphoma: Neuropathological Findings and Results of Mefloquine Treatment

Yasuteru Sano, Yuta Nakano, Masatoshi Omoto, Masaki Takao, Eiji Ikeda, Atsunori Oga, Kazuo Nakamichi, Masayuki Saijo, Takashi Maoka, Hironori Sano, Motoharu Kawai, Takashi Kanda

Author information

Yasuteru Sano
Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Japan
Yuta Nakano
Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Japan
Masatoshi Omoto
Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Japan
Masaki Takao
Department of Neuropathology, the Brain Bank for Aging Research, Tokyo Metropolitan Geriatric Hospital, Japan
Eiji Ikeda
Department of Pathology, Yamaguchi University Graduate School of Medicine, Japan
Atsunori Oga
Department of Pathology, Yamaguchi University Graduate School of Medicine, Japan
Kazuo Nakamichi
Department of Virology I, National Institute of Infectious Disease, Japan
Masayuki Saijo
Department of Virology I, National Institute of Infectious Disease, Japan
Takashi Maoka
Research Institute for Production Development, Japan
Hironori Sano
Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Japan
Motoharu Kawai
Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Japan
Takashi Kanda
Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Japan

Keywords: non-Hodgkin lymphoma, progressive multifocal leukoencephalopathy, rituximab, mefloquine, JC polyoma virus

JOURNAL OPEN ACCESS

2015 Volume 54 Issue 8 Pages 965-970

DOI https://doi.org/10.2169/internalmedicine.54.2308

Details

Abstract

A 66-year-old man with non-Hodgkin lymphoma (NHL) developed progressive multifocal leukoencephalopathy (PML) after undergoing chemotherapy including rituximab. Although the administration of mefloquine at a dose of 500 mg weekly temporarily led to a dramatic decrease in the copy number of JC Virus DNA in the cerebrospinal fluid, the patient's symptoms gradually worsened. The CD4⁺ T count remained continuously low, at least until approximately five months after the last cycle of chemotherapy. A postmortem examination performed 10 months after the onset of PML disclosed a severe condition associated with rituximab-treated PML originating from NHL and a high mefloquine concentration in the brain. The accumulation of further data regarding mefloquine treatment in PML cases may help to elucidate the optimal dosage and time window for effectively treating PML.

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