Progressive multifocal leukoencephalopathy secondary to idiopathic CD4 lymphocytopenia treated with pembrolizumab

J Neuroimmunol. 2023 Dec 15:385:578248. doi: 10.1016/j.jneuroim.2023.578248. Epub 2023 Nov 18.

Abstract

Background: Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating disease due to a lytic infection of oligodendrocytes caused by John Cunningham polyoma virus (JCV) infection. Idiopathic CD4+ T-cell lymphocytopenia (ICL) is a very rare cause of PML.

Methods: We present an individual with PML secondary to ICL treated with 3 doses of pembrolizumab, a Programmed-Death-1 Immune Checkpoint Inhibitor following with complete resolution of symptoms and conduct a review of the literature.

Conclusion: This report illustrates the objective clinical and radiological improvement in a patient with PML due to ICL and suggests further study of immune checkpoint inhibitors as potential treatment for patients with PML.

Keywords: Idiopathic lymphocytopenia; John Cunningham Virus; Neuroinflammation; PD-1 Checkpoint Inhibitor; Pembrolizumab; Progressive multifocal leukoencephalopathy.

Publication types

  • Review

MeSH terms

  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Humans
  • JC Virus*
  • Leukoencephalopathy, Progressive Multifocal* / diagnostic imaging
  • Leukoencephalopathy, Progressive Multifocal* / drug therapy
  • Leukoencephalopathy, Progressive Multifocal* / etiology
  • T-Lymphocytopenia, Idiopathic CD4-Positive* / complications
  • T-Lymphocytopenia, Idiopathic CD4-Positive* / drug therapy

Substances

  • pembrolizumab
  • Antibodies, Monoclonal, Humanized