Progressive multifocal Leukoencephalopathy as a complication of Lymphoma Therapy - a Case Report

We are describing the case of a 69-year-old male patient who had been treated since the year 2000 for chronic lymphocytic leukemia. Initially, he was treated with cytostatic agents and rituximab. After the third progression of the disease, the patient received four cycles of FCR (Fludarabine, Cyclophosphamide, Rituximab) since May 2006 with the achievement of complete remission. Two months after the completion of the therapy, the patient developed organic psychosyndrome with right-sided hemiparesis. Evaluation of the patient's brain using magnetic resonance imaging (MRI) revealed multiple non-expanding lesions in the white matter in both frontal lobes, non-opacifying after the administration of a contrast agent. Electron microscope examination demonstrated JC virus in the cerebrospinal fluid and also in the blood and urine. Despite antiviral treatment with high dose of aciclovir, the patient's clinical condition progressed into quadriplegia during several days. Subsequently the patient developed a comatose condition with fatal septic shock. Immunohistochemical examination of the white matter demonstrated presence of the JC virus and massive demyelination. The case was concluded as a rare progressive multifocal leukoencephalopathy in an immunocompromised patient treated for a lymphoproliferative disease.