Ineffective mefloquine therapy in progressive multifocal leukoencephalopathy complicated with malignant lymphoma: finding and usefulness of susceptibility-weighted imaging

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  • Morimoto Aya
    The Post-graduate Clinical Training Center, Hiroshima University Hospital Department of Neurology, Hiroshima University Hospital
  • Ueno Hiroki
    Department of Neurology, Hiroshima University Hospital
  • Fujii Hiroki
    Department of Neurology, Hiroshima University Hospital
  • Nakamura Takeshi
    Department of Neurology, Hiroshima University Hospital
  • Nakamichi Kazuo
    Department of Virology I, National Institute of Infectious Diseases
  • Saijo Masayuki
    Department of Virology I, National Institute of Infectious Diseases
  • Yukitake Motohiro
    Division of Neurology, Department of Internal medicine, Faculty of Medicine, Saga University
  • Matsumoto Masayasu
    Department of Neurology, Hiroshima University Hospital

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Other Title
  • 診断に磁化率強調画像が有用で，メフロキン投与にて改善をみとめなかった悪性リンパ腫合併進行性多巣性白質脳症の1例
  • シンダン ニ ジカリツ キョウチョウ ガゾウ ガ ユウヨウ デ,メフロキン トウヨ ニテ カイゼン オ ミトメナカッタ アクセイ リンパシュ ガッペイ シンコウセイ タソウセイ ハクシツ ノウショウ ノ 1レイ

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Abstract

A 57-year-old woman presented with motor and cognitive impairments under treatment for cryptogenic organizing pneumonia with immunosuppressive agents. Magnetic resonance imaging showed widespread signal abnormalities in the cerebral white matter. Susceptibility-weighted imaging showed attenuated contrast of the cerebral medullary vein in the lesions, and 18F-fluorodeoxyglucose-positron emission tomography (18F-FDG-PET) revealed decreased uptake at the same site and increased uptake in multifocal lung involvements. Lung biopsy findings were consistent with diffuse large B-cell lymphoma. Polymerase chain reaction for JC Virus DNA in cerebrospinal fluid yielded positive results. Based on these findings, the present case was given a diagnosis of progressive multifocal leukoencephalopathy (PML). The patient was treated with oral mefloquine, but her respiratory condition deteriorated and chemotherapy was required to prevent further deterioration. As a result, chemotherapy to treat lymphoma could not result in beneficial immune reconstitution, PML continued to progress despite mefloquine treatment, and the patient developed decorticate posture. The efficacy of mefloquine in patients with non-HIV-associated PML warrants further investigation.

Journal

  • Rinsho Shinkeigaku

    Rinsho Shinkeigaku 53 (10), 843-847, 2013

    Societas Neurologica Japonica

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