Favourable outcome of progressive multifocal leucoencephalopathy in two patients with dermatomyositis
- S Vulliemoz1,
- F Lurati-Ruiz2,
- F-X Borruat3,
- J Delavelle4,
- I J Koralnik5,
- T Kuntzer6,
- J Bogousslavsky6,
- F Picard1,
- T Landis1,
- R A Du Pasquier6
- 1Service de Neurologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland
- 2Service d’ Immunologie et allergologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- 3Unité de Neuro-ophtalmologie, Centre Hospitalier Universitaire Vaudois, Lausanne
- 4Unité de Neuro-radiologie, Hôpitaux Universitaires de Genève
- 5HIV/Neurology Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- 6Service de Neurologie, Centre Hospitalier Universitaire Vaudois
- Correspondence to: R A Du Pasquier Service de Neurologie and Service d’Immunologie, Centre Hospitalier Universitaire Vaudois, BT-02 1011 Lausanne, Switzerland;
- Received 27 March 2006
- Accepted 3 June 2006
- Revised 29 May 2006
Progressive multifocal leucoencephalopathy (PML), a demyelinating disease caused by the JC virus (JCV), occurs in immunosuppressed patients and carries a poor prognosis. A favourable outcome is reported in two patients with PML and dermatomyositis. Immunosuppressive drugs were stopped in patient 1 but could only be partially tapered in patient 2. The JCV-specific CD8+ T cell response was strong in patient 1 and weak in patient 2. Both were treated with cytosine-arabinoside, and patient 2 was also treated with mirtazapine, a 5HT2A receptor antagonist. Combination of these drugs might be helpful to treat HIV-negative patients with PML.
- Ara-C, cytosine-arabinoside
- JCV, JC virus
- MRI, magnetic resonance imaging
- PCR, polymerase chain reaction
- PML, progressive multifocal leucoencephalopathy
This work was supported in part by grants from the Swiss National Foundation (FN 3200BO-104262 and PP00B-106716) and from the Swiss Society for Multiple Sclerosis to RADP, and grants R01 NS/AI 041198 and 047029 from the National Institutes of Health, USA to IJK.
Competing interests: None declared.
Informed consent was obtained from the patients described in this report.