mycophenolic-acid and Cognitive-Dysfunction

The incidence of Epstein-Barr virus (EBV)associated lymphoproliferative disorders has increased with greater use of immunomodulatory therapies. We present a woman who developed subacute cognitive decline and unilateral weakness while taking long-term mycophenolate mofetil for granulomatosis with polyangiitis; her postmortem brain histopathology confirmed an EBV-driven lymphoproliferative disorder. Clinicians must have a high index of suspicion for EBV-driven lymphoma in people taking long-term immunosuppression who develop new neurological problems. We review the role of mycophenolate mofetil in EBV-driven lymphoproliferative disorders, and discuss checking EBV status in all patients starting immunosuppression and in older people already taking immunosuppression.

Topics: Aged; Cerebral Hemorrhage; Cognitive Dysfunction; Epstein-Barr Virus Infections; Female; Humans; Immunosuppression Therapy; Immunosuppressive Agents; Lymphoproliferative Disorders; Mycophenolic Acid

Topics: Adult; Antibiotics, Antineoplastic; Cognitive Dysfunction; Cyclosporine; Drug Therapy, Combination; Fluorescein Angiography; Glucocorticoids; Humans; Immunosuppressive Agents; Infusions, Intravenous; Lupus Erythematosus, Systemic; Male; Methylprednisolone; Mycophenolic Acid; Retinal Vasculitis; Vision, Low; Visual Acuity