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

doi:10.2169/internalmedicine.5288-20

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 journal › Article › peer-review

3 Citations (Scopus)

Abstract

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 language	English
Pages (from-to)	2927-2930
Number of pages	4
Journal	Internal Medicine
Volume	59
Issue number	22
DOIs	https://doi.org/10.2169/internalmedicine.5288-20
Publication status	Published - Nov 15 2020

Keywords

COVID-19
Cognitive dysfunction
Leukoencephalopathy
TCZ
Tocilizumab

ASJC Scopus subject areas

Internal Medicine

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10.2169/internalmedicine.5288-20

Cite this

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title = "Tocilizumab-induced leukoencephalopathy with a reversible clinical course",

abstract = "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.",

keywords = "COVID-19, Cognitive dysfunction, Leukoencephalopathy, TCZ, Tocilizumab",

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

note = "Funding Information: This work was partly supported by a Grant-in-Aid for Scientific Research (B) 17H0419611, (C) 15K0931607, 17H0975609, and 17K1082709, and by Grants-in-Aid from the Research Committees (Kaji R, Toba K, and Tsuji S) from the Japan Agency for Medical Research and Development 7211800049, 7211800130, Publisher Copyright: {\textcopyright} 2020 Japanese Society of Internal Medicine. All rights reserved.",

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language = "English",

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AU - Sasaki, Ryo

AU - Hishikawa, Nozomi

AU - Nomura, Emi

AU - Omote, Yosio

AU - Takemoto, Mami

AU - Yamashita, Toru

AU - Hatanaka, Noriko

AU - Higashi, Yasuto

AU - Abe, Koji

N1 - Funding Information: This work was partly supported by a Grant-in-Aid for Scientific Research (B) 17H0419611, (C) 15K0931607, 17H0975609, and 17K1082709, and by Grants-in-Aid from the Research Committees (Kaji R, Toba K, and Tsuji S) from the Japan Agency for Medical Research and Development 7211800049, 7211800130, Publisher Copyright: © 2020 Japanese Society of Internal Medicine. All rights reserved.

PY - 2020/11/15

Y1 - 2020/11/15

N2 - 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.

AB - 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.

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Tocilizumab-induced leukoencephalopathy with a reversible clinical course

Abstract

Keywords

ASJC Scopus subject areas

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