Journal
INTERNAL MEDICINE
Volume 54, Issue 8, Pages 965-970Publisher
JAPAN SOC INTERNAL MEDICINE
DOI: 10.2169/internalmedicine.54.2308
Keywords
non-Hodgkin lymphoma; progressive multifocal leukoencephalopathy; rituximab; mefloquine; JC polyoma virus
Categories
Funding
- Ministry of Health, Labour and Welfare of Japan
- JSPS KAKENHI from the Japan Society for the Promotion of Science, Tokyo, Japan [23790994]
- Comprehensive Brain Research Network
- Ministry of Health, Labour and Welfare of Japan [H23-Nanchi-Ippan-013, H24-AIDS-Wakate-002]
- Grants-in-Aid for Scientific Research [23790994] Funding Source: KAKEN
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A 66-year-old man with non-Hodgkin lymphoma (NHL) developed progressive multifocal leukoencephalopathy (PML) after undergoing chemotherapy including rituximab. Although the administration of mefloquine at a dose of 500 mg weekly temporarily led to a dramatic decrease in the copy number of JC Virus DNA in the cerebrospinal fluid, the patient's symptoms gradually worsened. The CD4(+) T count remained continuously low, at least until approximately five months after the last cycle of chemotherapy. A postmortem examination performed 10 months after the onset of PML disclosed a severe condition associated with rituximab-treated PML originating from NHL and a high mefloquine concentration in the brain. The accumulation of further data regarding mefloquine treatment in PML cases may help to elucidate the optimal dosage and time window for effectively treating PML.
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