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Brain Lesion in the Setting of Chronic Rituximab Treatment

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Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
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Article Information

Corresponding Author: Milad Yazdani, MD, Radiology and Radiological Science, Medical University of South Carolina, 96 Jonathan Lucas St, MSC 323, Charleston, SC 29425 (yazdani@musc.edu).

Published Online: May 28, 2020. doi:10.1001/jamaoncol.2020.0160

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient’s husband for granting permission to publish this information.

References
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Padgett  BL , Walker  DL , ZuRhein  GM , Eckroade  RJ , Dessel  BH .  Cultivation of papova-like virus from human brain with progressive multifocal leucoencephalopathy.   Lancet. 1971;1(7712):1257-1260. doi:10.1016/S0140-6736(71)91777-6PubMedGoogle ScholarCrossref
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Koralnik  IJ , Schellingerhout  D , Frosch  MP .  Case 14-2004—a 66-year-old man with progressive neurologic deficits.   N Engl J Med. 2004;350(18):1882-1893. doi:10.1056/NEJMcpc030038PubMedGoogle ScholarCrossref
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Aksoy  S , Harputluoglu  H , Kilickap  S ,  et al.  Rituximab-related viral infections in lymphoma patients.   Leuk Lymphoma. 2007;48(7):1307-1312. doi:10.1080/10428190701411441PubMedGoogle ScholarCrossref
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Carson  KR , Evens  AM , Richey  EA ,  et al.  Progressive multifocal leukoencephalopathy after rituximab therapy in HIV-negative patients: a report of 57 cases from the Research on Adverse Drug Events and Reports project.   Blood. 2009;113(20):4834-4840. doi:10.1182/blood-2008-10-186999PubMedGoogle ScholarCrossref
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Cortese  I , Muranski  P , Enose-Akahata  Y ,  et al.  Pembrolizumab treatment for progressive multifocal leukoencephalopathy.   N Engl J Med. 2019;380(17):1597-1605. doi:10.1056/NEJMoa1815039PubMedGoogle ScholarCrossref
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Küpper  C , Heinrich  J , Kamm  K , Bücklein  V , Rothenfusser  S , Straube  A .  Pembrolizumab for progressive multifocal leukoencephalopathy due to primary immunodeficiency.   Neurol Neuroimmunol Neuroinflamm. 2019;6(6):e628. doi:10.1212/NXI.0000000000000628PubMedGoogle Scholar
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Pawlitzki  M , Schneider-Hohendorf  T , Rolfes  L ,  et al.  Ineffective treatment of PML with pembrolizumab: exhausted memory T-cell subsets as a clue?   Neurol Neuroimmunol Neuroinflamm. 2019;6(6):e627. doi:10.1212/NXI.0000000000000627PubMedGoogle Scholar
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