A 69-year-old woman presented with subacute abulia, memory impairment, and gait disturbance, 5 months after completing 6 cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy for systemic diffuse large B-cell lymphoma. Magnetic resonance imaging (MRI) of the brain revealed multifocal white matter abnormalities on Fluid-attenuated inversion recovery imaging (Figure 1A), suspicious for progressive multifocal leukoencephalopathy, and subsequently confirmed on brain biopsy. The patient received 4 treatments with pembrolizumab, based on recent reports of possible efficacy.1 At 4-month follow-up, there was cognitive improvement and repeat MRI brain (Figure 1B) showed stabilization/improvement in white matter changes with accompanying atrophy.
Figure 1.
A, MRI brain FLAIR images showing multifocal, nonenhancing (not shown) white matter abnormalities. B, On 4-month follow-up: MRI brain FLAIR images showing significant stabilization/resolution of FLAIR abnormalities with associated atrophy in previously affected areas. FLAIR indicates Fluid-attenuated inversion recovery; MRI, magnetic resonance imaging.
Footnotes
Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: The authors received no financial support for the research, authorship, and/or publication of this article.
ORCID iD: Ronak K. Kapadia, MD, FRCPC 
https://orcid.org/0000-0002-9820-0486
Reference
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