RESUMO
Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating disease caused by reactivation of a latent JC polyoma virus. The first cases of PML were described 50 years ago in patients with lymphoma. PML typically occurs in immunocompromised individuals, particularly those infected with HIV. We present a 52-year-old male with lymphoma who was treated with R-CHOP (R: Rituximab; C: Cyclophosphamide; H: Doxorubicin; O: Vincristine; P: Prednisone). After six cycles of therapy, the patients developed tonic-clonic seizure. MRI of the brain showed multiple brain lesions. The pathology of a brain biopsy was diagnostic for PML. We review radiographic and histopathological features of the disease. The literature on PML and its association with immunosuppressant agents is reviewed, and the impact of rituximab and other biological agents in the setting is highlighted.
Assuntos
Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Leucoencefalopatia Multifocal Progressiva/induzido quimicamente , Linfoma/tratamento farmacológico , Rituximab/efeitos adversos , Rituximab/uso terapêutico , Biópsia , Encéfalo/diagnóstico por imagem , Histocitoquímica , Humanos , Imuno-Histoquímica , Leucoencefalopatia Multifocal Progressiva/patologia , Imageamento por Ressonância Magnética , Masculino , Microscopia , Pessoa de Meia-Idade , RadiografiaRESUMO
Acanthamoeba species are free-living protozoa that can infect humans and animals. Acanthamoeba can cause serious central nervous system infections in immunocompromised hosts. Here we report a case of Acanthamoeba encephalitis in a patient with lupus nephritis, 1 month after completing a course of rituximab, an anti-CD20 chimeric antibody.
Assuntos
Acanthamoeba/isolamento & purificação , Amebíase/parasitologia , Anticorpos Monoclonais Murinos/uso terapêutico , Encefalite/parasitologia , Nefrite Lúpica/tratamento farmacológico , Nefrite Lúpica/parasitologia , Encéfalo/parasitologia , Encéfalo/patologia , Evolução Fatal , Humanos , Fatores Imunológicos/uso terapêutico , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , RituximabRESUMO
We report a 47-year-old male patient who developed acute kidney injury requiring hemodialysis, associated with massive enlargement of both kidneys. A part from intra-abdominal lymphadenopathy, there was no other organ or lymph node involvement. A kidney biopsy established the diagnosis of non-Hodgkin's lymphoma. The patient received chemotherapy with good response. This case demonstrates that the kidney could be the primary organ involved in non-Hodgkin's lymphoma. In addition, we have shown that renal biopsy is adequate to make a diagnosis of lymphoma without the need to do more invasive testing.
