Report of Progressive Multifocal Leukoencephalopathy After Platinum-Based Therapy for Ovarian Cancer
Posted: Friday, September 6, 2019
Progressive multifocal leukoencephalopathy (PML)—a demyelinating disease of the central nervous system—is caused by the John Cunningham virus, an oligodendrocyte-lysing pathogen that can reactivate in the setting of immunosuppression. The Journal of Oncology Practice recently published a case report of drug-induced PML as an adverse reaction to treatment with carboplatin and paclitaxel—despite initial normal lymphocyte counts—in a woman with advanced ovarian cancer.
A 2-day history of slurred speech and right-hand clumsiness were the presenting symptoms for a 78-year-old woman with stage IIIC high-grade serous ovarian carcinoma, according to Poornima Jayadev Menon, MB, BCh, BAO, MRCPI, of the Mater Misercordiae University Hospital, Dublin, Ireland, and colleagues. The patient, who had completed three cycles of carboplatin and paclitaxel 1 month prior to presentation, also had mild dysarthria and expressive dysphasia. Fever began on day 7 of admission and continued despite broad-spectrum antimicrobials. The lymphocyte count was initially normal, but it trended downward to a nadir of 0.27 x 109/L by week 7.
The patient continued to clinically deteriorate, with unintelligible speech, marked ataxia, and progressive right-arm weakness with elbow extension. An interval magnetic resonance imaging (MRI) brain scan at week 4 showed multifocal subcortical T2-weighted fluid-attenuated inversion recovery hyperintensities without postcontrast enhancement. Additionally, cerebrospinal fluid (CSF) was inflammatory, and CSF cytology showed reactive lymphocytosis.
By week 6, the patient developed focal motor seizures of the right upper extremity. “Repeat MRI brain scans revealed interval progression,” noted the authors.
The patient was started on a trial of steroids for possible immune-mediated processes, but they were stopped immediately when a CSF John Cunningham virus polymerase chain reaction was positive for PML. Four months after initial presentation, she was fully dependent on her care providers and was transferred to hospice care.
Disclosure: The authors’ disclosure information can be found at ascopubs.org.