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or allogeneic 4 transplantation has been suggested. We report the first case of a woman with a non Hodgkin lymphoma (NHL) who developed PML after a combination of rituximab with chemotherapy as first line treatment. A 67-year-old woman suffered from a mantle cell lymphoma diagnosed on splenomegaly and hyperlym- phocytosis. Staging showed a stage IV with bone mar- row involvement. The patient was treated with a com- bination of rituximab (375 mg/m 2 ) and chemotherapy with standard CHOP: cyclophosphamide 750 mg/m 2 , doxorubicin 50 mg/m 2 , vincristin 2 mg, and oral predni- son 100 mg given in 3-week cycles. She received eight cycles of treatment. Evaluation after the eight cycles showed a complete remission. One month after the last chemotherapy, the patient rapidly presented psychiatric disturbances with speech dysfunction and paranoia delirium. PML was suspected on magnetic resonance imaging showing frontal and temporal leukoen- cephalopathy. JC viral DNA was detected in the cere- brospinal fluid. HIV serology was negative. Her total lymphocyte count was 470/∝L with 110/∝L CD4 + and 310/∝L CD8 + . Peripheral B cells were decreased with

JC papovavirus leukoencephalopathy after first line treatment with CHOP and rituximab