Favorable Response to Mirtazapine in John Cunningham Virus-related Gray Matter Lesion in a Patient with Human Immunodeficiency Virus

Alwehaibi, Abdullah I; AlJaber, Mohammed I; Nahrir, Shahpar

doi:10.7759/cureus.4255

Cited by 3 publications

(1 citation statement)

References 19 publications

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“…In life-threatening cases, gradual but accelerated cessation of immunosuppressive therapy and graft nephrectomy are necessary to save the patient's life [10,11]. There have been reports on the effectiveness of certain drugs for treating JCV disease in immunocompromised patients with or without nephropathy [34][35][36][37][38]. These drugs include mirtazapine, cytarabine, leflunomide, cidofovir, quinolones, and sorafenib.…”

Section: Therapeutic Optionsmentioning

confidence: 99%

JC Virus in Kidney Transplant Population: Are We Cautious Enough?

Pjanic,

Aleckovic-Halilovic,

Basic-Jukic

2024

JCM

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The John Cunningham virus (JCV) is a polyomavirus that usually infects people at a young age and does not cause any symptoms in immunocompetent individuals. However, in immunocompromised individuals, such as kidney transplant recipients, JCV can cause severe and potentially fatal disease. Unfortunately, JCV has not been researched as extensively as the BK virus and is not mentioned in relevant kidney transplant guidelines. This lack of attention to JCV can lead to less consideration in kidney transplant patients’ care. Surveillance using locally available diagnostic methods is of the utmost importance. The presence of JCV can be diagnosed with urine decoy cells, viruria, or viremia verified by the PCR method. A low threshold for considering JCV as a possible cause of any neurological or renal dysfunction in kidney transplant recipients must be maintained. In such cases, kidney and brain biopsy are indicated. Maintaining the appropriate immunosuppression while avoiding over-immunosuppression to prevent JCV disease is crucial, and the approach should be individual, according to overall immunological risk. We hypothesize that the presence of the JCV can indicate overt immunosuppression and identify kidney transplant recipients more prone to opportunistic infections and diseases, including some malignancies. To explore that, future observational studies are needed.

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Section: Therapeutic Optionsmentioning

confidence: 99%

JC Virus in Kidney Transplant Population: Are We Cautious Enough?

Pjanic,

Aleckovic-Halilovic,

Basic-Jukic

2024

JCM

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Therapeutic advances in neuroinfectious diseases

Ardakani,

Jia,

Matthews

et al. 2024

Therapeutic Advances in Infection

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There have been several major advances in therapeutic options for the treatment of neurological infections over the past two decades. These advances encompass both the development of new antimicrobial therapies and the repurposing of existing agents for new indications. In addition, advances in our understanding of the host immune response have allowed for the development of new immunomodulatory strategies in the treatment of neurological infections. This review focuses on the key advances in the treatment of neurological infections, including viral, bacterial, fungal, and prion diseases, with a particular focus on immunomodulatory treatment options. This review also highlights the process by which clinicians can request access to therapeutic agents on a compassionate or emergency basis when they may not be commercially available. While many therapeutic advances have been achieved in the past several years, there remains a pressing need for the continued development of additional therapeutic agents in the treatment of neurological infections.

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Progressive multifocal leukoencephalopathy associated with chemotherapy induced lymphocytopenia in solid tumors – case report of an underestimated complication

et al. 2022

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BackgroundJC virus reactivation causing progressive multifocal leukoencephalopathy (PML) occurs preferentially in human immunodeficiency virus (HIV) positive individuals or patients suffering from hematologic neoplasms due to impaired viral control. Reactivation in patients suffering from solid malignancies is rarely described in published literature.Case PresentationHere we describe a case of PML in a male patient suffering from esophageal cancer who underwent neoadjuvant radiochemotherapy and surgical resection in curative intent resulting in complete tumor remission. The radiochemotherapy regimen contained carboplatin and paclitaxel (CROSS protocol). Since therapy onset, the patient presented with persistent and progredient leukopenia and lymphopenia in absence of otherwise known risk factors for PML. Symptom onset, which comprised aphasia, word finding disorder, and paresis, was apparent 7 months after therapy initiation. There was no relief in symptoms despite standard of care PML directed supportive therapy. The patient died two months after therapy onset.ConclusionPML is a very rare event in solid tumors without obvious states of immununosuppression and thus harbors the risk of unawareness. The reported patient suffered from lymphopenia, associated with systemic therapy, but was an otherwise immunocompetent individual. In case of neurologic impairment in patients suffering from leukopenia, PML must be considered – even in the absence of hematologic neoplasia or HIV infection.

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Favorable Response to Mirtazapine in John Cunningham Virus-related Gray Matter Lesion in a Patient with Human Immunodeficiency Virus

Cited by 3 publications

References 19 publications

JC Virus in Kidney Transplant Population: Are We Cautious Enough?

JC Virus in Kidney Transplant Population: Are We Cautious Enough?

Therapeutic advances in neuroinfectious diseases

Progressive multifocal leukoencephalopathy associated with chemotherapy induced lymphocytopenia in solid tumors – case report of an underestimated complication

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