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• Vol.63 No.8
• CLINICA NEUROL, 63: 513−517, 2023
• Vol.63 No.8 contents

Case Report

A case of progressive multifocal leukoencephalopathy associated with daratumumab, bortezomib, and dexamethasone for multiple myeloma

Kojiro Usui, M.D.¹⁾, Yuki Kitazaki, M.D.¹⁾, Soichi Enomoto, M.D.¹⁾, Mihoko Morita, M.D., Ph.D.²⁾, Kazuo Nakamichi, Ph.D.³⁾ and Tadanori Hamano, M.D., Ph.D.¹⁾

¹⁾ Department of Neurology, University of Fukui Hospital
²⁾ Department of Hematology and Oncology, University of Fukui Hospital
³⁾ Department of Virology 1, National Institute of Infectious Diseases

An 83-year-old man presented with visual disturbance and right hemiparalysis, one month after daratumumab, bortezomib, and dexamethasone administration for multiple myeloma (MM). Blood screens revealed a CD4+ Tlymphocyte count of 132/µl. Diffusion weighted and fluid-attenuated inversion-recovery MR imaging showed high intensity signals in the both occipital lobes and left precentral area. The patient had no history of human immunodeficiency virus infection. Cerebrospinal fluid (CSF) JC virus (JCV) was positive (83 copies/ml), as indicated by PCR. The patient was diagnosed with progressive multifocal leukoencephalopathy (PML). MM treatment was discontinued, and mefloquine and mirtazapine therapy was started. However, the CSF JCV-DNA PCR count did not improve (111 copies/ml) after 30 days from starting mefloquine and mirtazapine therapy. The patient died six months after symptom onset. Conclusively, patients with decreased CD4+ T lymphocyte counts following DBd therapy for MM, the possibility of PML should be considered.
Full Text of this Article in Japanese PDF (1233K)

(CLINICA NEUROL, 63: 513−517, 2023)
key words: progressive multifocal leukoencephalopathy, JC virus-DNA PCR, multiple myeloma, daratumumab

(Received: 16-Feb-23)