Leukoencephalopathy with Cognitive Impairment following Tocilizumab for the Treatment of Rheumatoid Arthritis (RA)

Katsuya Kobayashi; Yoko Okamoto; Haruhisa Inoue; Takashi Usui; Masafumi Ihara; Jun Kawamata; Yukio Miki; Tsuneyo Mimori; Hidekazu Tomimoto; Ryosuke Takahashi

doi:10.2169/internalmedicine.48.1926

CASE REPORTS

Leukoencephalopathy with Cognitive Impairment following Tocilizumab for the Treatment of Rheumatoid Arthritis (RA)

Katsuya Kobayashi, Yoko Okamoto, Haruhisa Inoue, Takashi Usui, Masafumi Ihara, Jun Kawamata, Yukio Miki, Tsuneyo Mimori, Hidekazu Tomimoto, Ryosuke Takahashi

Author information

Katsuya Kobayashi
Department of Neurology, Kyoto University Hospital
Yoko Okamoto
Department of Neurology, Kyoto University Hospital
Haruhisa Inoue
Department of Neurology, Kyoto University Hospital
Takashi Usui
Department of Rheumatology and Clinical Immunology, Kyoto University Hospital
Masafumi Ihara
Department of Neurology, Kyoto University Hospital
Jun Kawamata
Department of Neurology, Kyoto University Hospital
Yukio Miki
Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital
Tsuneyo Mimori
Department of Rheumatology and Clinical Immunology, Kyoto University Hospital
Hidekazu Tomimoto
Department of Neurology, Mie University Hospital
Ryosuke Takahashi
Department of Neurology, Kyoto University Hospital

Keywords: rheumatoid arthritis, tocilizumab, leukoencephalopathy, cognitive impairment, MRI, interleukin 6

JOURNAL OPEN ACCESS

2009 Volume 48 Issue 15 Pages 1307-1309

DOI https://doi.org/10.2169/internalmedicine.48.1926

Details

Abstract

The biological agent tocilizumab, is a humanized, anti-human interleukin-6 receptor antibody. A 72-year-old woman developed cognitive impairment during the Phase III clinical trial of tocilizumab for the treatment of rheumatoid arthritis. MRI demonstrated hyperintense dissemination throughout the white matter on T2WI. An initial diagnosis of possible progressive multifocal leukoencephalopathy was made, but the PCR for JC virus DNA was negative in the CSF. The leukoencephalopathy might have been caused by a mechanism related to tocilizumab itself. It is strongly recommended to perform MRI if a patient develops any cognitive impairment during tocilizumab therapy.

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