Etanercept
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Progressive multifocal leukoencephalopathy in an elderly patient: case report A 74-year-old woman developed progressive multifocal leukoencephalopathy (PML) during treatment with etanercept. The woman, who was admitted with rheumatoid arthritis, started receiving etanercept 25mg twice weekly; she also started receiving isoniazid for tuberculosis prophylaxis. She was discharged after 3 weeks; however, the following month, she developed petechiae on her limbs and low-grade fever. The woman’s symptoms were suspected to be side effects of isoniazid and this was replaced by rifampicin. However, about 7 months after etanercept initiation, she was admitted due to loss of appetite and severe general malaise; the same month, etanercept was discontinued. About 1 month after admission, she developed occasional confusion and urinary incontinence, with gradual deterioration of verbal communication (Hasegawa’s dementia scale score of 6). The next month, she was transferred to a hospital following seizures and loss of consciousness. On this admission, she had Babinski’s reflex and neck rigidity. Laboratory investigations showed mild thrombocytopenia and leucocytosis; she had a C-reactive protein level of 19.75 mg/dL. Cerebrospinal fluid (CSF) analysis showed the following: protein level 84 mg/dL, cell count 30/3µL [sic] and glucose level 138 mg/dL. Brain MRI revealed high-intensity lesions, which were disseminated bilaterally throughout her white matter. She was initially diagnosed with encephalomeningitis and started receiving antibacterials, globulins, antifungals and aciclovir. Her inflammation rapidly resolved; however, abnormal reflexes and confusion continued and she had no improvement in speech. About 3 months after etanercept discontinuation, her CSF protein level had further increased and brain MRI showed greater dissemination of her white matter lesions. Following this, she was diagnosed with PML. She had a tendency to stay in bed but, with supportive therapy, her condition improved so that she could sit up for meals. She was transferred to a sanatorium where rehabilitation was continued. Yamamoto M, et al. Leukoencephalopathy during administration of etanercept for refractory rheumatoid arthritis. Modern rheumatology / the Japan Rheumatism 801070635 Association 17: 72-74, 2007 - Japan
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Reactions 7 Apr 2007 No. 1146
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