Progressive Multifocal Leukoencephalopathy Following Combined Rituximab-Based Immune-Chemotherapy for Post-transplant Lymphoproliferative Disorder in a Renal Transplant Recipient: A Case Report

Transplant Proc. 2018 Apr;50(3):881-883. doi: 10.1016/j.transproceed.2018.01.004.

Abstract

Background: Transplant recipients are at risk of developing progressive multifocal leukoencephalopathy (PML), an opportunistic infection due to reactivation of JC virus. Post-transplant lymphoproliferative disorders (PTLDs) represent a common malignancy in this population, and antiCD20-therapy has become an established component of its treatment.

Case presentation: We describe the first case of a renal allograft transplant recipient with PTLD who received rituximab-based immune-chemotherapy and developed PML shortly thereafter. Despite early suspicion and diagnosis, the disease ran a relentlessly progressive course, and the patient succumbed to his illness shortly thereafter.

Conclusion: PML should be strongly suspected whenever unusual neurologic symptoms appear in the context of immunosuppression. Clinicians and patients should be aware of the potential for PML after rituximab therapy.

Publication types

  • Case Reports

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / adverse effects*
  • Humans
  • Immunocompromised Host*
  • JC Virus
  • Kidney Transplantation / adverse effects*
  • Leukoencephalopathy, Progressive Multifocal / chemically induced
  • Leukoencephalopathy, Progressive Multifocal / immunology*
  • Lymphoma, B-Cell / drug therapy
  • Lymphoma, B-Cell / immunology
  • Male
  • Middle Aged
  • Rituximab / adverse effects*

Substances

  • Rituximab