Tocilizumab-induced leukoencephalopathy with a reversible clinical course

Ryo Sasaki, Nozomi Hishikawa, Emi Nomura, Yosio Omote, Mami Takemoto, Toru Yamashita, Noriko Hatanaka, Yasuto Higashi, Koji Abe

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


Tocilizumab (TCZ; Actemra/RoActemra) is an anti-interleukin (IL)-6 receptor antibody for the treatment of rheumatoid arthritis (RA) and other autoimmune diseases and cytokine storms. The present case is a 63-year-old female well-controlled RA patient, who presented with a progressive cognitive impairment after 34 months of TCZ administration. Brain magnetic resonance imaging (MRI) showed leukencephalopathy with a lactic acid peak in magnetic resonance spectroscopy (MRS), a decreased blood flow in single photon emission computed tomography (SPECT), and a decreased accumulation in fluorodeoxyglucose positron emission tomography (FDG-PET). The discontinuation of TCZ improved her cognitive function and brain MRI findings at 3 months after drug cessation. The present case suggests that TCZ may sometimes cause leukoencephalopathy after long-term administration, and thus the early discontinuation of TCZ is recommended to achieve a good prognosis.

Original languageEnglish
Pages (from-to)2927-2930
Number of pages4
JournalInternal Medicine
Issue number22
Publication statusPublished - Nov 15 2020


  • COVID-19
  • Cognitive dysfunction
  • Leukoencephalopathy
  • TCZ
  • Tocilizumab

ASJC Scopus subject areas

  • Internal Medicine


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