• PDF / 170,938 Bytes
• 1 Pages / 595.245 x 841.846 pts (A4) Page_size
• 118 Downloads / 161 Views

DOWNLOAD

REPORT

---

1 S

Progressive multifocal leukoencephalopathy: case report A 78-year-old woman developed progressive multifocal leukoencephalopathy (PML) during treatment with carboplatin and paclitaxel for ovarian carcinoma. The woman presented with a 2-day history of right-hand clumsiness and slurred speech. She was receiving carboplatin and paclitaxel for stage 3C high-grade serous ovarian carcinoma and had received three cycles one month prior to the presentation [doses and routes not stated]. There was no past history of immunosuppression. A mild dysarthria and expressive dysphasia were reported. She had right upper extremity finger-nose ataxia with elbow extension weakness of grade of 4 out of 5. She was admitted. Brain MRI revealed non-specific T2-weighted fluid-attenuated inversion recovery (T2 FLAIR) hyperintensities. On day 7 of admission, the woman presented with fever which persisted despite increased unspecified broad-spectrum antimicrobials. A septic screen was found negative. Lymphocyte count was initially normal and then decreased to a nadir of 0.27 x 109/L by week 7. HIV serology as well as autoimmune and para-neoplastic antibodies were found negative. She continued to deteriorate clinically. She had marked ataxia, progressive right-arm weakness with elbow extension and unintelligible nonsensical speech. At week 4, a repeat brain MRI demonstrated multifocal subcortical T2 FLAIR hyperintensities without post-contrast enhancement. Cerebrospinal fluid (CSF) was inflammatory with 10 white cells/uL and 100% lymphocytic. CSF protein and glucose were unremarlable, CSF viral film array was negative, and CSF cytology indicated reactive lymphocytosis. On week 6 following admission, she developed focal motor seizures of the right upper extremity, consistent with epilepsia partialis continua. An electroencephalogram showed frequent left mid-temporal sharp waves along with intermittent left hemispheric focal δ-range slowing. Seizures were successfully treated with levetiracetam and clonazepam. A repeat brain MRI showed interval progression. Afterwards, she was initiated on a trial of steroids considering possible immune-mediated processes. However, by week 7, there was no clinical or radiologic improvement. A CSF John Cunningham virus PCR led to the diagnosis of PML. The steroids were discontinued immediately. She was started mirtazepine. Four months following the initial presentation, she was dependent on her care providers. She was then transferred to hospice care. Menon PJ, et al. Progressive Multifocal Leukoencephalopathy After Carboplatin and Paclitaxel Chemotherapy for Ovarian Carcinoma. Journal of Oncology Practice 15: 803499078 554-555, No. 10, Oct 2019. Available from: URL: http://doi.org/10.1200/JOP.19.00196

0114-9954/20/1820-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved

Reactions 5 Sep 2020 No. 1820