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Infante et al. Neuroimmunol Neuroinflammation 2017;4:211-5 Neuroimmunology and
DOI: 10.20517/2347-8659.2016.52
Neuroinflammation

www.nnjournal.net
Case Report Open Access

A case of atypical progressive multifocal

encephalopathy mimicking acute ischemic

stroke: case report and review of literature

Maria Teresa Infante , Giovanni Novi , Riccarda Gentile , Laura Malfatto , Lucio Castellan , Carlo Serrati ,
3
1
1
1,2
1
1
Laura Barletta 3
1 Neurology Unit, Department of Neurosciences, IRCCS San Martino IST, Largo Rosanna Benzi 10, 16132 Genoa, Italy.
2 Department of Neurology, Ophtalmology, Genetics, Maternal and Child Health, University of Genoa, Largo Daneo 3, 16132 Genoa, Italy.
3 Neuroradiology Unit, IRCCS San Martino IST, Largo Rosanna Benzi 10, 16132 Genoa, Italy.
Correspondence to: Dr. Maria Teresa Infante, Neurology Unit, Deparment of Neurosciences, IRCCS San Martino IST, Largo Rosanna Benzi 10,
16132 Genoa, Italy. E-mail: infante.mariateresa@gmail.com
How to cite this article: Infante MT, Novi G, Gentile R, Malfatto L, Castellan L, Serrati C, Barletta L. A case of atypical progressive multifocal
encephalopathy mimicking acute ischemic stroke: case report and review of literature. Neuroimmunol Neuroinflammation 2017;4:211-5.
Dr. Maria Teresa Infante is a young neurologist; she attended her neurology residency at Genoa’s University (Italy)
and she did her research especially in the field of neuroimmunology diseases.

ABSTRACT
Article history: Progressive multifocal encephalopathy (PML) is a rare but often fatal infectious brain
Received: 25 Nov 2016 disease caused by the reactivation of John Cunningham polyomavirus. Reactivation occurs
Accepted: 10 Jul 2017 in immunocompromised individuals with AIDS and leukemia, on chemotherapy or being
Published: 19 Oct 2017 treated with immunosuppressant drugs (e.g. monoclonal antibodies). Cases of PML have been
described in patients treated with natalizumab, efalizumab and rituximab used, respectively,
Key words: for the treatment of (1) multiple sclerosis, (2) psoriasis and (3) haematological malignancies
Progressive multifocal or systemic autoimmune diseases (rheumatoid arthritis and systemic lupus erythematosus).
encephalopathy, The authors describe an unusual case of acute brainstem and cerebellar PML following
rituximab, chemotherapy for chronic lymphatic leukemia diagnosed 4 years before the onset of PML in
immunosuppression a 75-year-old man. The patient was treated with high dose chemotherapy and rituximab with
complete response. The onset of symptoms of PML was very rapid and occurred after more
than two years from last rituximab infusion; patient had a sudden neurological deterioration,
with rapid progression to death in about a month from the onset of symptoms. Lesions were
localized in the cerebellum, brainstem and such pattern has been reported in very few cases in
the literature.

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