Bharat et al reported a number of risk factors associated with progressive multifocal leukoencephalopathy (PML) in a patient with a rheumatic disease. It is important to consider this diagnosis if the patient develops neurologic symptoms. The authors are from the University of Alabama at Birmingham, Cleveland Clinic, Vanderbilt University and Oregon Health Sciences University.
Patient selection: rheumatic or autoimmune disease
Risk factors associated with PMLs:
(1) HIV infection
(2) cancer
(3) therapy with infliximab or rituximab or other targeted agent (typically in conjunction with other immunosuppressive agents)
(4) therapy with cytotoxic drugs (see top of page 614, second column)
Identifying any risk factors is important, since discontinuation or treatment may stabilize the neurologic disability.
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