Progressive multifocal leukoencephalopathy in systemic lupus erythematosus treated with pembrolizumab

BMJ Case Rep. 2024 Sep 19;17(9):e260624. doi: 10.1136/bcr-2024-260624.

Abstract

This case report discusses a patient with systemic lupus erythematosus (SLE) treated with low-dose azathioprine who developed progressive multifocal leukoencephalopathy (PML). PML is a rare, severe, demyelinating disease linked to John Cunningham polyomavirus (JCV) reactivation.Treated with pembrolizumab, an immune checkpoint inhibitor, the patient initially improved. However, after the fourth dose, her condition rapidly worsened resulting in treatment discontinuation and death. Similar cases highlight the complex interplay of factors in PML development in SLE patients, including immunosuppression and genetic factors. The use of pembrolizumab in PML and SLE necessitates careful consideration of potential complications.

Keywords: Immune Checkpoint Inhibitors; Infection (neurology); Systemic lupus erythematosus.

Publication types

  • Case Reports

MeSH terms

  • Antibodies, Monoclonal, Humanized* / adverse effects
  • Antibodies, Monoclonal, Humanized* / therapeutic use
  • Azathioprine / adverse effects
  • Azathioprine / therapeutic use
  • Fatal Outcome
  • Female
  • Humans
  • Immune Checkpoint Inhibitors / adverse effects
  • Immunosuppressive Agents / adverse effects
  • Immunosuppressive Agents / therapeutic use
  • JC Virus / isolation & purification
  • Leukoencephalopathy, Progressive Multifocal* / chemically induced
  • Leukoencephalopathy, Progressive Multifocal* / diagnosis
  • Lupus Erythematosus, Systemic* / complications
  • Lupus Erythematosus, Systemic* / drug therapy
  • Magnetic Resonance Imaging

Substances

  • pembrolizumab
  • Antibodies, Monoclonal, Humanized
  • Immunosuppressive Agents
  • Azathioprine
  • Immune Checkpoint Inhibitors