Case Reports in Clinical Medicine, 2020, 9, 96-106 https://www.scirp.org/journal/crcm ISSN Online: 2325-7083 ISSN Print: 2325-7075 DOI: 10.4236/crcm.2020.94015 Apr. 9, 2020 96 Case Reports in Clinical Medicine Cerebral Localization of Chronic Lymphocytic Leukemia Simulating Progressive Multifocal Leukoencephalopathy: The Lessons from a Case T. M. Sandouno 1* , S. Chebrek 2 , C. Tchonko 2 , G. Pichancourt 3 , L. Giovannetti 2 , H. Zerazhi 2 , Romain Appay 4 , H. Lepidi 4 , H. Bachir 1 , S. Hamaz 1 , H. B. Alaoui 1 , K. Serraj 1 , B. Slama 2 1 Internal Medicine Department, Mohammed VI University Hospital Center, Mohammed I University, Oujda, Morocco 2 Onco-hematology department, Henri Duffaut Hospital Center, Avignon, France 3 Infectiology Departement, Henri Duffaut Hospital Center, Avignon, France 4 Department of Pathological Anatomy and Neuropathology, Timone University Hospital Center, Marseille, France Abstract Background: Central neurological involvement is the most frequent extra he- matological manifestation of chronic lymphocytic leukemia; it is multifactorial and rarely due to a cerebral localization of the disease. We report a case of cer- ebral localization of chronic lymphoid leukemia whose clinical and radiological aspects were very suggestive of progressive multifocal leukoencephalopathy. Case Presentation: A 65-year-old patient who was HIV-negative (human immu- nodeficiency virus), had consulted for bilateral axillary, cervical and inguinal lymphadenopathy associated with major asthenia and hyper lymphocytosis (lymphocyte count was 11 giga/l). Chronic lymphocyticleukemia with TP53 mutation was diagnosed and treatment with Ibrutinib 420 mg/day was initiat- ed. After 2 months of treatment, the evolution was marked by the onset of neu- rological disorders whose clinical-radiological presentation and temporal evo- lution had led to the diagnosis of progressive multifocal leukoencephalopathy. In the absence of virological evidence in the cerebrospinal fluid analysis, a stereotactic biopsy of the brain lesions had been performed, making it possi- ble to formally rule out this infectious hypothesis and to demonstrate cerebral invasion by tumour cells. Immuno-chemotherapy combining Rituximab- Cyclophosphamide-Doxorubicin-Vincristine-Prednisone-Ibrutinib (RCHOP- Ibrutinib) with intrathecal chemotherapy resulted in a very good clinical- radiological response. Conclusion: The appearance of neurological manifes- tations in the context of chronic lymphocytic leukemia must systematically lead to a search for a cerebral localization of the disease. In the absence of vi- rological evidence in the cerebrospinal fluid, any suspicion of progressive How to cite this paper: Sandouno, T.M., Chebrek, S., Tchonko, C., Pichancourt, G., Giovannetti, L., Zerazhi, H., Appay, R., Lepidi, H., Bachir, H., Hamaz, S., Alaoui, H.B., Serraj, K. and Slama, B. (2020) Cere- bral Localization of Chronic Lymphocytic Leukemia Simulating Progressive Multifo- cal Leukoencephalopathy: The Lessons from a Case. Case Reports in Clinical Medicine, 9, 96-106. https://doi.org/10.4236/crcm.2020.94015 Received: February 2, 2020 Accepted: April 6, 2020 Published: April 9, 2020 Copyright © 2020 by author(s) and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/ Open Access