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dc.contributor.authorGarrote, Heidys
dc.contributor.authorde la Fuente, Adolfo
dc.contributor.authorOña, Raquel
dc.contributor.authorRodríguez, Inmaculada
dc.contributor.authorEchevarria, Juan Emilio 
dc.contributor.authorSepúlveda, Juan M
dc.contributor.authorGarcía, Juan F
dc.identifier.citationExp Hematol Oncol. 2015; 4:8
dc.description.abstractA 50-year-old male with chronic lymphocytic leukemia (CLL) was treated with fludarabine, cyclophosphamide and rituximab, which produced a complete remission. Eight months after the last dose of rituximab he had visual disturbance, diminished muscular strength in the right arm and vesicular-papular lesions in the left ophthalmic branch region of the V cranial nerve. These were initially interpreted as herpes virus encephalopathy (HVE), but brain magnetic resonance imaging (MRI) showed evidence of demyelination consistent with progressive multifocal leukoencephalopathy (PML). Cerebrospinal fluid (CSF) analysis was negative for varicella zoster virus (VZV) and John Cunningham virus (JCV) DNA. The clinical suggestion of PML prompted us to perform a brain biopsy and to start treatment with mefloquine. In the brain biopsy, histopathological features of demyelination were described and the polymerase chain reaction (PCR) identified JCV, confirming the diagnosis of PML. Treatment with mefloquine (250 mg/week) and dexamethasone (4 mg/day) was started and maintained for 6 months. A year later there was an almost complete resolution of the MRI lesions and the patient achieved a stable clinical state with persisting motor impairment and severe epilepsy. The patient is alive 38 months after diagnosis of PML, which is the longest known survival to date.
dc.description.sponsorshipSupported by grants from the Fondo de Investigaciones Sanitarias - Ministerio de Ciencia e Innovación (PI12/1832), Plan Nacional of I + D + I co-financed by ISCIII-Subdirección General de Evaluación and Fondo Europeo de Desarrollo Regional (FEDER). HG has a grant from Fundación BBVA - Fundación Carolina.
dc.publisherBioMed Central
dc.relation.isversionofPublisher's version
dc.subjectProgressive multifocal leukoencephalopathy
dc.subjectJohn Cunningham virus
dc.subjectImmune system suppression
dc.titleLong-term survival in a patient with progressive multifocal leukoencephalopathy after therapy with rituximab, fludarabine and cyclophosphamide for chronic lymphocytic leukemia
dc.rights.licenseAtribución 4.0 Internacional*
dc.contributor.funderInstituto de Salud Carlos III - ISCIII
dc.identifier.journalExperimental Hematology & Oncology
dc.repisalud.centroISCIII::Centro Nacional de Microbiología::Área de Virología

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Atribución 4.0 Internacional
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