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Infectious Diseases
Progressive multifocal leukoencephalopathy in systemic lupus erythematosus treated with pembrolizumab
  1. Matilde Ørum1,2,
  2. Alex Lund Laursen1,3 and
  3. Anne Troldborg3,4
  1. 1Department of Infectious Diseases, Aarhus University Hospital, Aarhus N, Denmark
  2. 2Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
  3. 3Aarhus University, Aarhus, Denmark
  4. 4Department of Rheumatology, Aarhus University Hospital, Aarhus N, Denmark
  1. Correspondence to Dr Anne Troldborg; annetrol{at}rm.dk

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.

  • Infection (neurology)
  • Systemic lupus erythematosus
  • Immune Checkpoint Inhibitors

https://doi.org/10.1136/bcr-2024-260624

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: MØ, AT and ALL. The following authors gave final approval of the manuscript: AT and ALL.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.