Case report of a patient with progressive multifocal leukoencephalopathy under treatment with dimethyl fumarate.
BMC Neurol
; 15: 108, 2015 Jul 08.
Article
em En
| MEDLINE
| ID: mdl-26152311
ABSTRACT
BACKGROUND:
Progressive multifocal leukoencephalopathy is a severe demyelinating disease caused by the polyoma JC virus in patients with reduced immunocompetence. A few cases of progressive multifocal leukoencephalopathy have been reported in patients treated with fumaric acid esters. CASE PRESENTATION A 53-year-old Caucasian woman reported to our clinic with a first focal epileptic seizure and mild cognitive impairment. Since 1.5 years, she was treated with fumaderm for her psoriasis. During that time, her lymphocyte counts ranged between 450 and 700/µl. Cerebral magnet resonance imaging showed multifocal subcortical T2 hyperintense lesions with partial gadolinium enhancement. She did not have antibodies against human immunodeficiency virus 1 and 2 and cerebrospinal fluid-polymerase chain reaction for viral infections including a sensitive JC-virus polymerase chain reaction were negative. The diagnosis of progressive multifocal leukoencephalopathy was established by histological analysis and detection of JC-virus desoxyribonucleic acid in brain biopsy specimens. Dimethyl fumarate was stopped and Mirtazapin and Mefloquin were initiated. Neurological examination and imaging remained stable.CONCLUSIONS:
Progressive multifocal leukoencephalopathy can occur in patients with lymphocyte counts between 450 and 700/µl, produce only faint symptoms and is not excluded by negative JC-virus-polymerase chain reaction in cerebrospinal fluid. The incidence of progressive multifocal leukoencephalopathy may thus be underestimated and a more careful surveillance of patients would be necessary.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Leucoencefalopatia Multifocal Progressiva
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Fumarato de Dimetilo
Limite:
Female
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Humans
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Middle aged
Idioma:
En
Ano de publicação:
2015
Tipo de documento:
Article