JC VIRUS INFECTION AND PROGRESSIVE MULTIFOCAL LEUCOENCEPHALOPATHY IN A PATIENT WITH THE B-CELL CHRONIC LYMPHOCYTIC LEUKAEMIA.

Introduction: B-cell chronic lymphocytic leukaemia (B-CLL) is characterized by an accumulation of long-lived, functionally inactive, mature-appearing neoplastic B-lymphocytes. It is associated with severe immunodeficiency. Chemotherapy or immunotherapy generally makes the immunodeficiency worse. JC virus (John Cunningham virus; JCV) is a type of human polyomavirus that causes the progressive multifocal leucoencephalopathy (PML). JCV is found in 70 to 90 percent of population. The virus remains in gastrointestinal tract or tubular cell of kidneys and may infect oligodendrocytes and astrocytes. Immunodeficiency or immunosupression associated with several drugs (e.g. monoclonal antibodies) or HIV infection allow the reactivation of JCV. Case-report: The authors present here a case of a 62-years old patient with B-CLL that was diagnosed 6 years ago. The patient underwent 4 courses of the first-line COP chemotherapy consisting of vincristine, cyclophosphamide and prednisone. A partial remission of the disease was achieved and the patient was on the maintenance therapy with chlorambucil for 5 years. The second-line COP chemotherapy and immunotherapy with rituximab was used because of B-CLL progression. Treatment was complicated with ischemic stroke and quadriparesis with left predominance. Magnetic resonance imaging (MRI) showed several cortical and subcortical lesions in frontal and parietal lobes bilaterally. Anticoagulation, vasodilatation and rehabilitation transitorily improved patient's clinical status. After the fifth course of immunotherapy, the patient suffered from dysarthria, disorientation and deterioration of personality. B-CLL infiltration of brain was suspected. The cerebrospinal fluid examination excluded central nervous system infiltration with B-CLL. MRI discovered progression of brain lesions and the diagnosis of PML was supposed. PCR detected the presence of JCV in cerebrospinal fluid and confirmed that diagnosis. Patient died in several weeks after diagnosis. Conclusion: Severe immunodeficiency during B-CLL treatment may lead to the reactivation of JCV in these patients and cause fatal PML. This work was supported by APVV 222-11; CEVYPET, and grant Vega 1/0016/12 projects. [ABSTRACT FROM AUTHOR]