A case of progressive multifocal leukoencephalopathy in a post-kidney transplant patient with improvement after discontinuation of immunosuppressive drugs and combination therapy with mefloquine and mirtazapine
Abstract Background Progressive multifocal leukoencephalopathy is a rare disease, but the prognosis is very poor, especially in the immunosuppressed state with a non-HIV background, and there is no established treatment. Case presentations A 49-year-old patient who had undergone a renal transplant a...
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| Format: | Article |
| Language: | English |
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BMC
2023-12-01
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| Series: | Renal Replacement Therapy |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s41100-023-00517-9 |
| _version_ | 1797376775603355648 |
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| author | Neri Sone Hiroki Nishiwaki Mayu Shimokawa Keishu Kawanishi Tsuyoshi Oshiro Reiji Takami Natsuki Taira Masahito Amagasa Shinya Omiya Tadahide Maezumi Yoko Nabeshima Kazuo Nakamichi Yoshiharu Miura Fumihiko Koiwa |
| author_facet | Neri Sone Hiroki Nishiwaki Mayu Shimokawa Keishu Kawanishi Tsuyoshi Oshiro Reiji Takami Natsuki Taira Masahito Amagasa Shinya Omiya Tadahide Maezumi Yoko Nabeshima Kazuo Nakamichi Yoshiharu Miura Fumihiko Koiwa |
| author_sort | Neri Sone |
| collection | DOAJ |
| description | Abstract Background Progressive multifocal leukoencephalopathy is a rare disease, but the prognosis is very poor, especially in the immunosuppressed state with a non-HIV background, and there is no established treatment. Case presentations A 49-year-old patient who had undergone a renal transplant and was receiving prednisolone and mycophenolate mofetil treatment was admitted for peritoneal dialysis initiation. While hospitalized, he experienced aphasia and other percutaneous symptoms. Magnetic resonance imaging of the brain revealed a subcortical demyelinating lesion. JC virus DNA was identified in cerebrospinal fluid, and he was diagnosed with progressive multifocal leukoencephalopathy. Immunosuppressant was ceased, and he was treated with mefloquine and mirtazapine. The patient subsequently underwent a head MRI scan, confirming lesion reduction, improved activities of daily life, and survival. Conclusions Progressive multifocal leukoencephalopathy is commonly observed in patients with compromised immune systems, which was the case for this patient due to long-standing immunosuppressive medication usage and end-stage renal failure necessitating dialysis. |
| first_indexed | 2024-03-08T19:43:28Z |
| format | Article |
| id | doaj.art-7ac480e9697543cb94fe68e46af7f003 |
| institution | Directory Open Access Journal |
| issn | 2059-1381 |
| language | English |
| last_indexed | 2024-03-08T19:43:28Z |
| publishDate | 2023-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Renal Replacement Therapy |
| spelling | doaj.art-7ac480e9697543cb94fe68e46af7f0032023-12-24T12:29:41ZengBMCRenal Replacement Therapy2059-13812023-12-01911610.1186/s41100-023-00517-9A case of progressive multifocal leukoencephalopathy in a post-kidney transplant patient with improvement after discontinuation of immunosuppressive drugs and combination therapy with mefloquine and mirtazapineNeri Sone0Hiroki Nishiwaki1Mayu Shimokawa2Keishu Kawanishi3Tsuyoshi Oshiro4Reiji Takami5Natsuki Taira6Masahito Amagasa7Shinya Omiya8Tadahide Maezumi9Yoko Nabeshima10Kazuo Nakamichi11Yoshiharu Miura12Fumihiko Koiwa13Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka HospitalDivision of Nephrology, Department of Internal Medicine, Showa University Fujigaoka HospitalDivision of Nephrology, Department of Internal Medicine, Showa University Fujigaoka HospitalDivision of Nephrology, Department of Internal Medicine, Showa University Fujigaoka HospitalDivision of Nephrology, Department of Internal Medicine, Showa University Fujigaoka HospitalDivision of Nephrology, Department of Internal Medicine, Showa University Fujigaoka HospitalDivision of Nephrology, Department of Internal Medicine, Showa University Fujigaoka HospitalDivision of Nephrology, Department of Internal Medicine, Showa University Fujigaoka HospitalDivision of Nephrology, Department of Internal Medicine, Showa University Fujigaoka HospitalDivision of Nephrology, Department of Internal Medicine, Showa University Fujigaoka HospitalDepartment of Neurology, Showa University Fujigaoka HospitalDepartment of Virology 1, National Institute of Infectious DiseasesDepartment of Neurology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome HospitalDivision of Nephrology, Department of Internal Medicine, Showa University Fujigaoka HospitalAbstract Background Progressive multifocal leukoencephalopathy is a rare disease, but the prognosis is very poor, especially in the immunosuppressed state with a non-HIV background, and there is no established treatment. Case presentations A 49-year-old patient who had undergone a renal transplant and was receiving prednisolone and mycophenolate mofetil treatment was admitted for peritoneal dialysis initiation. While hospitalized, he experienced aphasia and other percutaneous symptoms. Magnetic resonance imaging of the brain revealed a subcortical demyelinating lesion. JC virus DNA was identified in cerebrospinal fluid, and he was diagnosed with progressive multifocal leukoencephalopathy. Immunosuppressant was ceased, and he was treated with mefloquine and mirtazapine. The patient subsequently underwent a head MRI scan, confirming lesion reduction, improved activities of daily life, and survival. Conclusions Progressive multifocal leukoencephalopathy is commonly observed in patients with compromised immune systems, which was the case for this patient due to long-standing immunosuppressive medication usage and end-stage renal failure necessitating dialysis.https://doi.org/10.1186/s41100-023-00517-9Progressive multifocal leukoencephalopathyImmunosuppressionMirtazapineMefloquine |
| spellingShingle | Neri Sone Hiroki Nishiwaki Mayu Shimokawa Keishu Kawanishi Tsuyoshi Oshiro Reiji Takami Natsuki Taira Masahito Amagasa Shinya Omiya Tadahide Maezumi Yoko Nabeshima Kazuo Nakamichi Yoshiharu Miura Fumihiko Koiwa A case of progressive multifocal leukoencephalopathy in a post-kidney transplant patient with improvement after discontinuation of immunosuppressive drugs and combination therapy with mefloquine and mirtazapine Renal Replacement Therapy Progressive multifocal leukoencephalopathy Immunosuppression Mirtazapine Mefloquine |
| title | A case of progressive multifocal leukoencephalopathy in a post-kidney transplant patient with improvement after discontinuation of immunosuppressive drugs and combination therapy with mefloquine and mirtazapine |
| title_full | A case of progressive multifocal leukoencephalopathy in a post-kidney transplant patient with improvement after discontinuation of immunosuppressive drugs and combination therapy with mefloquine and mirtazapine |
| title_fullStr | A case of progressive multifocal leukoencephalopathy in a post-kidney transplant patient with improvement after discontinuation of immunosuppressive drugs and combination therapy with mefloquine and mirtazapine |
| title_full_unstemmed | A case of progressive multifocal leukoencephalopathy in a post-kidney transplant patient with improvement after discontinuation of immunosuppressive drugs and combination therapy with mefloquine and mirtazapine |
| title_short | A case of progressive multifocal leukoencephalopathy in a post-kidney transplant patient with improvement after discontinuation of immunosuppressive drugs and combination therapy with mefloquine and mirtazapine |
| title_sort | case of progressive multifocal leukoencephalopathy in a post kidney transplant patient with improvement after discontinuation of immunosuppressive drugs and combination therapy with mefloquine and mirtazapine |
| topic | Progressive multifocal leukoencephalopathy Immunosuppression Mirtazapine Mefloquine |
| url | https://doi.org/10.1186/s41100-023-00517-9 |
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