A Case of John Cunningham Virus Induced Rhombencephalitis after Rituximab Therapy for Idiopathic Thrombocytopenic Purpura
Background. John Cunningham virus (JCV) is known to cause progressive multifocal leukoencephalopathy (PML) in immuno-compromised patients due to lytic infection of oligodendrocytes and astrocytes. Rarely, it may also present as granule cell neuronopathy (GCN), leading to degeneration of cerebellar g...
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| Format: | Article |
| Language: | English |
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Wiley
2021-01-01
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| Series: | Case Reports in Infectious Diseases |
| Online Access: | http://dx.doi.org/10.1155/2021/5525053 |
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| author | Silpita Katragadda Varshaa Koneru Genevieve Devany Aaron S. DeWitt Vasudev H. Tati |
| author_facet | Silpita Katragadda Varshaa Koneru Genevieve Devany Aaron S. DeWitt Vasudev H. Tati |
| author_sort | Silpita Katragadda |
| collection | DOAJ |
| description | Background. John Cunningham virus (JCV) is known to cause progressive multifocal leukoencephalopathy (PML) in immuno-compromised patients due to lytic infection of oligodendrocytes and astrocytes. Rarely, it may also present as granule cell neuronopathy (GCN), leading to degeneration of cerebellar granule cell neurons. It is described in patients with underlying conditions or medication contributing to immune compromise. Case Presentation. A 73-year-old man presented with ataxia and difficulty in speech which began 3 months after initiation of treatment for idiopathic thrombocytopenic purpura with rituximab. Neurological examination was significant for torsional nystagmus, motor aphasia, right-sided dysmetria, and dysdiadochokinesia with gait ataxia. Magnetic resonance imaging (MRI) showed right cerebellar lesion and cerebrospinal fluid (CSF) polymerase chain reaction (PCR) was positive for JC virus. Conclusion. The diagnosis of JC virus-related cerebellar disease can be missed, due to the subacute to chronic onset and challenges in detection. Clinicians should have a high degree of suspicion for development of these symptoms, even a few months after initiation of immune-modulatory therapy because the progression and outcomes can be disastrous. |
| format | Article |
| id | doaj-art-521fa27261184cad943dca019cc27acb |
| institution | Kabale University |
| issn | 2090-6625 2090-6633 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Infectious Diseases |
| spelling | doaj-art-521fa27261184cad943dca019cc27acb2025-02-03T07:23:59ZengWileyCase Reports in Infectious Diseases2090-66252090-66332021-01-01202110.1155/2021/55250535525053A Case of John Cunningham Virus Induced Rhombencephalitis after Rituximab Therapy for Idiopathic Thrombocytopenic PurpuraSilpita Katragadda0Varshaa Koneru1Genevieve Devany2Aaron S. DeWitt3Vasudev H. Tati4Baton Rouge General Internal Medicine Residency Program, Baton Rouge General Medical Center, Baton Rouge, LA 70809, USABaton Rouge General Internal Medicine Residency Program, Baton Rouge General Medical Center, Baton Rouge, LA 70809, USABaton Rouge General Internal Medicine Residency Program, Baton Rouge General Medical Center, Baton Rouge, LA 70809, USABaton Rouge General Internal Medicine Residency Program, Baton Rouge General Medical Center, Baton Rouge, LA 70809, USABaton Rouge General Internal Medicine Residency Program, Baton Rouge General Medical Center, Baton Rouge, LA 70809, USABackground. John Cunningham virus (JCV) is known to cause progressive multifocal leukoencephalopathy (PML) in immuno-compromised patients due to lytic infection of oligodendrocytes and astrocytes. Rarely, it may also present as granule cell neuronopathy (GCN), leading to degeneration of cerebellar granule cell neurons. It is described in patients with underlying conditions or medication contributing to immune compromise. Case Presentation. A 73-year-old man presented with ataxia and difficulty in speech which began 3 months after initiation of treatment for idiopathic thrombocytopenic purpura with rituximab. Neurological examination was significant for torsional nystagmus, motor aphasia, right-sided dysmetria, and dysdiadochokinesia with gait ataxia. Magnetic resonance imaging (MRI) showed right cerebellar lesion and cerebrospinal fluid (CSF) polymerase chain reaction (PCR) was positive for JC virus. Conclusion. The diagnosis of JC virus-related cerebellar disease can be missed, due to the subacute to chronic onset and challenges in detection. Clinicians should have a high degree of suspicion for development of these symptoms, even a few months after initiation of immune-modulatory therapy because the progression and outcomes can be disastrous.http://dx.doi.org/10.1155/2021/5525053 |
| spellingShingle | Silpita Katragadda Varshaa Koneru Genevieve Devany Aaron S. DeWitt Vasudev H. Tati A Case of John Cunningham Virus Induced Rhombencephalitis after Rituximab Therapy for Idiopathic Thrombocytopenic Purpura Case Reports in Infectious Diseases |
| title | A Case of John Cunningham Virus Induced Rhombencephalitis after Rituximab Therapy for Idiopathic Thrombocytopenic Purpura |
| title_full | A Case of John Cunningham Virus Induced Rhombencephalitis after Rituximab Therapy for Idiopathic Thrombocytopenic Purpura |
| title_fullStr | A Case of John Cunningham Virus Induced Rhombencephalitis after Rituximab Therapy for Idiopathic Thrombocytopenic Purpura |
| title_full_unstemmed | A Case of John Cunningham Virus Induced Rhombencephalitis after Rituximab Therapy for Idiopathic Thrombocytopenic Purpura |
| title_short | A Case of John Cunningham Virus Induced Rhombencephalitis after Rituximab Therapy for Idiopathic Thrombocytopenic Purpura |
| title_sort | case of john cunningham virus induced rhombencephalitis after rituximab therapy for idiopathic thrombocytopenic purpura |
| url | http://dx.doi.org/10.1155/2021/5525053 |
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