Posterior reversible encephalopathy syndrome masquerading as progressive multifocal leukoencephalopathy in rituximab treated neuromyelitis optica.

Abstract

Both progressive multifocal leukoencephalopathy (PML) and posterior reversible encephalopathy syndrome (PRES) have been reported as complications of rituximab therapy. These disorders may appear indistinguishable on magnetic resonance imaging (MRI). We report on a 42 year old woman with neuromyelitis optica (NMO) of 10 years duration who developed extensive white matter disease affecting chiefly both parietal lobes 6 months after her first and only dose of rituximab. The MRI findings suggested the diagnosis of PML, but her history was more consistent with PRES. Ultimately, a brain biopsy was performed which was consistent with the diagnosis of PRES. PRES and PML may have overlapping symptomatology and be indistinguishable on MRI. An approach to distinguishing between these two disorders is addressed.

• Authors: Joseph R Berger, Janna Neltner, Charles Smith, Franca Cambi
• Journal: Multiple sclerosis and related disorders (Mult Scler Relat Disord) Vol. 3 Issue 6 Pg. 728-31 (Nov 2014) ISSN: 2211-0356 [Electronic] Netherlands
• PMID: 25891552 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2014. Published by Elsevier B.V.

Chemical References

• Antibodies, Monoclonal, Murine-Derived
• Immunologic Factors
• Rituximab

Topics

• Adult
• Antibodies, Monoclonal, Murine-Derived (adverse effects, therapeutic use)
• Brain (drug effects, pathology)
• Diagnosis, Differential
• Female
• Humans
• Immunologic Factors (adverse effects, therapeutic use)
• Leukoencephalopathy, Progressive Multifocal (diagnosis, pathology)
• Magnetic Resonance Imaging
• Neuromyelitis Optica (complications, drug therapy, pathology)
• Posterior Leukoencephalopathy Syndrome (chemically induced, diagnosis, pathology)
• Rituximab