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• W4387267268 abstract "SESSION TITLE: Critical Care Case Report Posters 12 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm INTRODUCTION: About 20–70% of individuals harbor the latent form of the JC human polyomavirus (JCV). Immunosuppression activates JCV, which can cause rare progressive multifocal leukoencephalopathy (PML). Below, we provide one such example. CASE PRESENTATION: A 73-year-old man presented with an abrupt onset of left-sided weakness that developed to complete paralysis of the left upper and lower extremities within one day. The family denied any history of fever, headache, seizures, recent travel, or sick contact. He was recently started on daratumumab and pomalidomide for his multiple myeloma after failing the initial treatment. On presentation, he had a temperature of 99.2 degrees F, a heart rate of 102 beats per minute, a respiratory rate of 22 breaths per minute, blood pressure of 110/90 mmHg, and an oxygen saturation of 94% on room air. Physical examination revealed only motor and sensory deficits in the left upper and lower extremities. The head computed tomography (CT) scan was unremarkable, however the magnetic resonance imaging (MRI) detected T2/FLAIR and diffusion signal abnormalities on the right side. Laboratory testing showed white blood cell count of 4,900/L with 79% polymorphonuclear cells, however, all other results were negative, including the respiratory panel, blood cultures, and immunology (ANA, ANCA, HIV). The lumbar puncture JCV DNA polymerase chain reaction (PCR) results were positive, with 6923 copies/ml. Pomalidomide was discontinued and the patient was discharged home for outpatient follow up. DISCUSSION: In healthy individuals JCV infection is asymptomatic and results in a chronic carrier state with antibodies present in 20-30% of healthy adults. However, disease states such as HIV/AIDS and lymphoproliferative diseases or immunomodulating therapies can lead to reactivation of the virus and manifests as PML. Very few cases of pomalidomide-associated PML have been reported thus far. In PML, the virus infects oligodendrocytes causing progressive demyelination and as such can be diagnosed with brain imaging. CT brain typically shows multiple asymmetric localized areas of hypoattenuation similar to a T1-weighted MRI. Conversely, the lesions are visualized as hyperintense on T2-weighted MRI and FLAIR. Gadolinium enhancement occurs rarely and may be associated with improved survival. Generally, the prognosis for PML is dire with a 33-50% mortality rate within the first few months. As there are no pharmacological treatments available, the best treatment option is immune reconstitution by discontinuation of the drug or ART in HIV patients. A survival rate of 71-92% has been reported after natalizumab discontinuation; perhaps a similar phenomenon can be observed in pomalidomide-associated PML but further research is required for concrete conclusions. CONCLUSIONS: With the recent increase in pomalidomide and various other immunomodulators use, there has been an emergence of PML cases. Prompt recognition of the presentation and discontinuation of immunomodulators is crucial. REFERENCE #1: Dunham SR, Schmidt R, Clifford DB. Treatment of Progressive Multifocal Leukoencephalopathy Using Immune Restoration. Neurotherapeutics. 2020;17(3):955-965. doi:10.1007/s13311-020-00848-z REFERENCE #2: Monge J, Contreras J, Elsoukkary S, et al. Progressive multifocal leukoencephalopathy in a patient with multiple myeloma receiving daratumumab and Pomalidomide. American Society of Hematology . 2019;134(Supplement 1):4876-4876. doi:10.1182/blood-2019-122134 REFERENCE #3: Progressive multifocal leukoencephalopathy/JC virus infection: NIH. Progressive Multifocal Leukoencephalopathy/JC Virus Infection | NIH. https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/progressive. Accessed March 19, 2023. DISCLOSURES: No relevant relationships by Asim Amjad No relevant relationships by Taibah Chaudhary No relevant relationships by Omaima Chaudhary No relevant relationships by Maria Nawaz No relevant relationships by Muhammad Hassan Shakir" @default.
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• W4387267268 date "2023-10-01" @default.
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• W4387267268 title "POMALIDOMIDE-ASSOCIATED PROGRESSIVE LEUKOENCEPHALOPATHY IN MULTIPLE MYELOMA PATIENTS: A CASE REPORT" @default.
• W4387267268 doi "https://doi.org/10.1016/j.chest.2023.07.1768" @default.
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