Rapid cognitive decline in a patient with chronic lymphocytic leukaemia: a case report

Autor: Jun Yong, James Forryan
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Male
Pediatrics
medicine.medical_specialty
Palliative care
lcsh:Medicine
Context (language use)
Neurological examination
Case Report
Ofatumumab
Antibodies
Monoclonal
Humanized
Polymerase Chain Reaction
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
Natalizumab
Medicine
Humans
Cognitive Dysfunction
Cognitive decline
Aged
medicine.diagnostic_test
business.industry
Progressive multifocal leukoencephalopathy
lcsh:R
Palliative Care
Leukoencephalopathy
Progressive Multifocal
Progressive multifocal leukoencephalopathy
Chronic lymphocytic leukaemia
Ofatumumab
Monoclonal antibodies
B-cell-depleting therapy
Brain
General Medicine
medicine.disease
JC Virus
Leukemia
Lymphocytic
Chronic
B-Cell
Hospice Care
chemistry
030220 oncology & carcinogenesis
Rituximab
Chlorambucil
business
030217 neurology & neurosurgery
medicine.drug
Zdroj: Journal of Medical Case Reports
Journal of Medical Case Reports, Vol 14, Iss 1, Pp 1-6 (2020)
ISSN: 1752-1947
Popis: Background The use of monoclonal antibodies in various settings has been linked to the development of progressive multifocal leukoencephalopathy (PML). Whilst this association is well-described with agents such as rituximab and natalizumab, the literature describing the occurrence of PML with ofatumumab therapy (especially in a haematology setting) is sparse. This case aims to draw attention to the above association with a particular focus on the mechanisms by which B-cell-depleting therapy can precipitate PML during the treatment of haematological malignancy. Case presentation A 68-year-old Caucasian man presented with acute-on-subacute confusion and reduced mobility. He had a history of chronic lymphocytic leukaemia for which he had completed six cycles of ofatumumab and chlorambucil 2 months prior to presentation. Biochemistry, physical examination and imaging were unremarkable on admission. Subsequent neurological examination demonstrated diminished reflexes and an extensor right plantar, while magnetic resonance imaging (MRI) assessment revealed white matter hyperintensities in the frontal lobes with restricted diffusion surrounding these areas. Cerebrospinal fluid (CSF) analysis demonstrated normal cell counts and chemistry but detected John Cunningham virus (JCV) via polymerase chain reaction (PCR), with a quantitative value of 41,850 gEg/ml. CSF immunophenotyping excluded malignant processes. A diagnosis of PML was confirmed, and with the support of palliative care, the patient was discharged to a hospice for ongoing care with the family’s agreement. Conclusion PML remains a rare complication of ofatumumab treatment. Nevertheless, clinicians should maintain a certain level of suspicion for this risk, especially in the context of patients presenting with clinical syndromes of encephalopathy and focal neurologic deficits. Furthermore, research to better our understanding of the manifold links between B-cell function and JCV regulation could provide valuable information for use in the future prevention and treatment of PML.
Databáze: OpenAIRE
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