Journal
ARTHRITIS AND RHEUMATISM
Volume 60, Issue 11, Pages 3225-3228Publisher
WILEY-BLACKWELL
DOI: 10.1002/art.24906
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Funding
- Wyeth
- Abbott
- Amgen
- AstraZeneca
- Centocor
- Glaxo-SmithKline
- Lilly
- Genentech
- Roche
- Pfizer
- UCB
- Biogen Idec.
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Progressive multifocal leukoencephalopathy (PML) is a rare brain disease caused by reactivation of the JC virus. Herein, a case of PML in association with rituximab treatment in a patient with chronic rheumatoid arthritis (RA) and Sjogren's syndrome is described. The patient received 4 courses of rituximab (21,000-mg infusions administered 2 weeks apart) over a period of similar to 40 months, during a phase III trial and safety extension study. PML was diagnosed similar to 18 months after the last rituximab course, and the patient died I month later. Determination of the cause of PML was confounded by the fact that the patient had developed oropharyngeal cancer, which was treated with chemoradiotherapy, 9 months prior to the development of PML. Although there was no direct evidence that linked rituximab to the development of PML, this case highlights the need to consider a diagnosis of PML in patients with RA who have been treated with rituximab and who subsequently develop new neurologic symptoms.
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