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Clinical Pathologic Conference
February 2016

Rapid Multifocal Neurologic Decline in an Immunocompromised Patient

Author Affiliations
  • 1Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
  • 2Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
  • 3Division of Hematology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
  • 4Neuropathology Specialty Group, Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
  • 5Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada
JAMA Neurol. 2016;73(2):226-231. doi:10.1001/jamaneurol.2015.2658
Abstract

A man in his early 70s with a diagnosis of chronic lymphocytic leukemia and being treated with prednisone, fludarabine, cyclophosphamide, and rituximab presented with progressive multifocal neurologic decline. The patient died 2 months after the onset of this decline despite extensive clinical and laboratory investigation and a trial of methylprednisolone therapy. The approach to the immunosuppressed patient with progressive neurologic decline, neuropathologic findings, and final diagnosis are discussed.

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