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.
Kromm JA, Power C, Blevins G, Larratt L, van Landeghem FKH, Rempel J. Rapid Multifocal Neurologic Decline in an Immunocompromised Patient. JAMA Neurol. 2016;73(2):226-231. doi:10.1001/jamaneurol.2015.2658