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A case report of progressive multifocal leucoencephalopathy (PML) associated with adalimumab
  1. Manoj Ray1,
  2. Jeffrey R Curtis2,
  3. John W Baddley1
  1. 1 Department of Medicine/Division of Infectious Diseases, University of Alabama at Birmingham, 1900 University Boulevard, Birmingham, Alabama, USA
  2. 2 Division of Clinical Immunology & Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
  1. Correspondence to Dr John W Baddley, Department of Medicine/Division of Infectious Diseases, University of Alabama at Birmingham, 1900 University Boulevard, 229 THT, Birmingham, AL 35294-0006, USA; jbaddley{at}uab.edu

https://doi.org/10.1136/annrheumdis-2013-204978

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    Case report

    Progressive multifocal leucoencephalopathy (PML) is a demyelinating disease of the central nervous system caused by polyomavirus JC. It results from lytic infection of glial cells and is often fatal.1 ,2 A common risk factor for PML is immunosuppression due to HIV infection or malignancy (or its treatment). PML has also been reported in those using immunomodulation therapies.3 A previous study estimated incidence of PML at 0.2/100 000 among patients with autoimmune diseases who did not have HIV or malignancy. Based on the single case of PML exposed to a biological agent, another study reported the incidence rate (IR) of PML was 2.3 (95% CI 0.1 to 71) per 100 000 person-years in patients who were exposed to biological agents and 0.8 (95% CI 0.2 to 2.5) per 100 000 person-years in those not exposed to biological agents.4

    Cases of PML associated …

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    Footnotes

    • Contributors MR and JWB provided the study concept and drafting of the manuscript. JWB and JRC supervised the study and critically revised the manuscript for important intellectual content.

    • Competing interests JWB: He is a consultant for Merck, Pfizer and Astellas. Pending research grant from Bristol-Myers Squibb (BMS). JRC: He receives salary support from National Institutes of Health (AR053351) and Agency for Healthcare Research and Quality (AHRQ) (R01 R01HS018517). He is a consultant and has received research support from Amgen, Janssen, Consortium of Rheumatology Researchers of North America (CORRONA), Pfizer, Roche/Genentech, Abbvie and UCB.

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