Significant improvement following combination treatment with mefloquine and mirtazapine in a patient with progressive multifocal leukoencephalopathy after allogeneic peripheral blood stem cell transplantation

We report a case of a 40-year-old female who developed progressive multifocal leukoencephalopathy (PML), which is associated with JC virus reactivation, after allogeneic hematopoietic cell transplantation. As she had been suffering from graft-versus-host disease and lung damage after pneumocystis pn...

Full description

Saved in:
Bibliographic Details
Published in:International journal of hematology 2014-01, Vol.99 (1), p.95-99
Main Authors: Yoshida, Hitoshi, Ohshima, Kenji, Toda, Jun, Kusakabe, Shinsuke, Masaie, Hiroaki, Yagi, Toshinari, Ishikawa, Jun
Format: Article
Language:English
Subjects:
Adult
Antiviral Agents - therapeutic use
Biological and medical sciences
Brain - pathology
Case Report
Drug Therapy, Combination
Female
Hematologic and hematopoietic diseases
Hematology
Human viral diseases
Humans
Infectious diseases
JC virus
Leukoencephalopathy, Progressive Multifocal - diagnosis
Leukoencephalopathy, Progressive Multifocal - drug therapy
Leukoencephalopathy, Progressive Multifocal - etiology
Magnetic Resonance Imaging
Medical sciences
Medicine
Medicine & Public Health
Mefloquine - therapeutic use
Mianserin - analogs & derivatives
Mianserin - therapeutic use
Oncology
Peripheral Blood Stem Cell Transplantation - adverse effects
Pneumocystis
Transplantation, Homologous
Treatment Outcome
Viral diseases
Viral diseases of the nervous system
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:We report a case of a 40-year-old female who developed progressive multifocal leukoencephalopathy (PML), which is associated with JC virus reactivation, after allogeneic hematopoietic cell transplantation. As she had been suffering from graft-versus-host disease and lung damage after pneumocystis pneumonia, the administration of calcineurin inhibitor and steroid could not be discontinued. However, she showed a favorable improvement in clinical symptoms and imaging findings after treatment with the anti-malarial drug, mefloquine and a serotonin receptor blocker, mirtazapine. Continuation of the treatment for eight months finally led to the clearance of the JC virus from her cerebrospinal fluid. She currently shows no neurological disturbance and has resumed her daily activities. PML due to the severe immunosuppressive condition has been reported as a fatal complication after allo-SCT. Our case suggests that combination treatment with mefloquine and mirtazapine may be of great value for the treatment for PML patients in the post allo-SCT setting, although it is difficult to say whether the combination treatment alone led to improvement. Further clinical study is needed to clarify the efficacy of these drugs for the treatment of PML.
ISSN:0925-5710
1865-3774
DOI:10.1007/s12185-013-1471-0