Back to Search
Start Over
Progressive multifocal leukoencephalopathy in a 27-year-old lady with systemic lupus erythematosus – rheumatoid arthritis overlap syndrome
- Source :
- Journal of the Formosan Medical Association, Vol 118, Iss 11, Pp 1560-1565 (2019)
- Publication Year :
- 2019
- Publisher :
- Elsevier, 2019.
-
Abstract
- Progressive multifocal leukoencephalopathy (PML) is a rare viral demyelinating disease of central nervous system. Immunosuppression is a significant risk factor for the disease. Previously, PML developed more commonly in patients of hematological malignancy and acquired immune deficiency syndrome (AIDS). In the era of biological disease modifying anti-rheumatic drugs, PML is more frequently reported in patients of autoimmune diseases. However, for its rarity and unspecific clinical presentations, accurate diagnosis and immediate immune restoration might be difficult in clinical practice, and the outcome might thus be miserable. Herein we present a 27-year-old lady of systemic lupus erythematosus (SLE) – rheumatoid arthritis overlap syndrome with suspected involvement of central nervous system. Neuropsychiatric SLE was suspected first. However, after intensive immunosuppressive treatment, the condition kept deteriorating. An alternative diagnosis was thus considered. PML was suspected for her immunosuppressive status and suggestive radiological findings, and the diagnosis was confirmed by a polymerase chain reaction of JC virus from cerebrospinal fluid. After restoring the immune status by decreasing the dose of immunosuppressants, the condition of the patient improved significantly. We report this case to raise the importance of clinical alertness for the rare but possibly underdiagnosed disease. Keywords: Antirheumatic agents, Rheumatoid arthritis, Immunosuppressive agents, Progressive multifocal leukoencephalopathy, Systemic lupus erythematosus
- Subjects :
- Adult
medicine.medical_specialty
medicine.medical_treatment
JC virus
Disease
medicine.disease_cause
Arthritis, Rheumatoid
03 medical and health sciences
0302 clinical medicine
Cerebrospinal fluid
medicine
Demyelinating disease
Humans
Lupus Erythematosus, Systemic
lcsh:R5-920
business.industry
Progressive multifocal leukoencephalopathy
Leukoencephalopathy, Progressive Multifocal
Immunosuppression
Overlap syndrome
Syndrome
General Medicine
medicine.disease
Dermatology
Antirheumatic Agents
030220 oncology & carcinogenesis
Rheumatoid arthritis
Female
030211 gastroenterology & hepatology
business
lcsh:Medicine (General)
Immunosuppressive Agents
Subjects
Details
- Language :
- English
- ISSN :
- 09296646
- Volume :
- 118
- Issue :
- 11
- Database :
- OpenAIRE
- Journal :
- Journal of the Formosan Medical Association
- Accession number :
- edsair.doi.dedup.....9bd1ddcf2c08bc023023de4beb03c77e