{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,21]],"date-time":"2025-09-21T16:53:35Z","timestamp":1758473615937,"version":"3.40.5"},"reference-count":26,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,12,3]],"date-time":"2018-12-03T00:00:00Z","timestamp":1543795200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neuropathology"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:p>Progressive multifocal leukoencephalopathy (PML) is a rare fatal demyelinating disease of the central nervous system caused by reactivation of the JC virus (JCV), which is named after the initials of the patient from whom the virus was first isolated. JCV is highly prevalent worldwide, infects humans in early childhood, and the infection persists throughout the course of life in latent form. The present paper deals with the second autopsy case report of rituximab\u2010associated PML in Japan. A 63\u2010year\u2010old woman who had undergone chemotherapy for non\u2010Hodgkin lymphoma developed progressive dysarthria and cerebellar ataxia. Head magnetic resonance imaging (MRI) revealed small, scattered, hyperintense areas in the midbrain, pons and thalamus, and the patient was first diagnosed as having cerebral infarction. Follow\u2010up MRI showed tendency toward cerebellar atrophy and multiple system atrophy cerebellar type was suggested, which we concluded must have coincidentally occurred. It was challenging to perform biopsy due to the location of the foci and the patient's condition. Twelve months later she died of aspiration pneumonia caused by the bulbar lesion. At autopsy, the histological examination suggested the presence of demyelinating foci with numerous foamy macrophages. In the foci, oligodendrocytes with enlarged ground\u2010glass like nuclei were found in a scattered manner and astrocytes with bizarre nuclei were also detected. These findings verified the case as PML. The first diagnosis of cerebral infarction was later withdrawn, although appropriate disorders were not recalled even after testing with various antibodies. The rate of PML development tends to increase after treatment with molecular\u2010targeted therapies, which directly or indirectly attenuate the cellular\u2010mediated immune system. Various novel molecular\u2010targeted and immunosuppressive drugs have been released on the market; the cases of PML have consequently increased. Accordingly, pathologists should keep this disease in mind in the differential diagnosis when neural symptoms newly emerge in patients who are treated with these drugs.<\/jats:p>","DOI":"10.1111\/neup.12526","type":"journal-article","created":{"date-parts":[[2018,12,4]],"date-time":"2018-12-04T03:29:56Z","timestamp":1543894196000},"page":"58-63","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["An autopsy case of progressive multifocal leukoencephalopathy after rituximab therapy for malignant lymphoma"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5251-5258","authenticated-orcid":false,"given":"Reiji","family":"Muto","sequence":"first","affiliation":[{"name":"Department of Pathology Kurume University School of Medicine  Kurume Japan"},{"name":"Department of Pathology National Hospital Organization, Kumamoto Medical Center  Kumamoto Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7250-457X","authenticated-orcid":false,"given":"Yasuo","family":"Sugita","sequence":"additional","affiliation":[{"name":"Department of Pathology Kurume University School of Medicine  Kurume Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seiya","family":"Momosaki","sequence":"additional","affiliation":[{"name":"Department of Pathology National Hospital Organization, Kyushu Medical Center  Fukuoka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuriko","family":"Ito","sequence":"additional","affiliation":[{"name":"Department of Cerebrovascular Disease and Clinical Research Institute National Hospital Organization, Kyushu Medical Center  Fukuoka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshiyuki","family":"Wakugawa","sequence":"additional","affiliation":[{"name":"Department of Cerebrovascular Disease and Clinical Research Institute National Hospital Organization, Kyushu Medical Center  Fukuoka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Koichi","family":"Ohshima","sequence":"additional","affiliation":[{"name":"Department of Pathology Kurume University School of Medicine  Kurume Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,12,3]]},"reference":[{"key":"e_1_2_6_2_1","first-page":"193","article-title":"Progressive multifocal leukoencephalopathy revisited: Has the disease outgrown its name?","volume":"19","author":"Koralnik IJ","year":"1999","journal-title":"Ann 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FDA warns about case of rare brain infection PML with MS drug Tecfidera (dimethyl fumarate). [Cited Nov 2014.]. 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