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Progressive Multifocal Leukoencephalopathy in Primary Immunodeficiencies

Abstract : Purpose: Progressive multifocal leukoencephalopathy (PML) is a rare but severe demyelinating disease caused by the polyoma-virus JC (JCV) in immunocompromised patients. We report a series of patients with primary immune deficiencies (PIDs) who developed PML. Methods: Retrospective observational study including PID patients with PML. Clinical, immunological, imaging features, and outcome are provided for each patient. Results: Eleven unrelated patients with PIDs developed PML. PIDs were characterized by a wide range of syndromic or genetically defined defects, mostly with combined B and T cell impairment. Genetic diagnosis was made in 7 patients. Before the development of PML, 10 patients had recurrent infections, 7 had autoimmune and/or inflammatory manifestations, and 3 had a history of malignancies. Immunologic investigations showed CD4 + lymphopenia (median 265, range 50-344) in all cases. Six patients received immunosuppressive therapy in the year before PML onset, including prolonged steroid therapy in 3 cases, rituximab in 5 cases, anti-TNF-α therapy, and azathioprine in 1 case each. Despite various treatments, all but 1 patient died after a median of 8 months following PML diagnosis. Conclusion: PML is a rare but fatal complication of PIDs. Many cases are secondary to immunosuppressive therapy warranting careful evaluation before initiation subsequent immunosuppression during PIDs.
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Submitted on : Wednesday, January 22, 2020 - 3:43:45 PM
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Jérôme Hadjadj, Aurélien Guffroy, Christophe Delavaud, Guillaume Taieb, Isabelle Meyts, et al.. Progressive Multifocal Leukoencephalopathy in Primary Immunodeficiencies. Journal of Clinical Immunology, 2019, 39 (1), pp.55-64. ⟨10.1007/s10875-018-0578-8⟩. ⟨pasteur-02448936⟩



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