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Washington University Experience | INFECTION | Viruses | PML (JC Virus) | PML - IRIS | 1A0 Case 1 History
Case 1 History ---- This man, 51 years old at the time of this biopsy, died 5 years later. He presented with right-sided weakness thought to represent an infarct; however, brain MRI showed a T2 signal abnormality involving white matter bilaterally more consistent with PML or Toxoplasmosis. CSF sent for JC virus PCR was negative as were routine cultures. Cryptococcus, AFB, Toxoplasmosis (received prophylactic pyrimethamine) were negative as were Epstein-Barr, HSV I, CMV and enterovirus PCR studies. Repeat MRI showed bilateral frontoparietal areas of enhancement and T2 hyperintensity suggestive of necrotizing encephalitic process which was unchanged from the previous MRI; a PET scan showed that the two MRI demonstrable frontoparietal white matter lesions had minimal FDG uptake, thought more suggestive of infectious or inflammatory process rather than neoplasm. Repeat CSF JC virus PCR was negative, prompting brain biopsy yielding a definitive diagnosis of PML. It was thought that PML in this patient was a part of a HAART-based reconstitution syndrome and, as a result, was treated successfully with intravenous steroids. He was lost to follow up for approximately 4 years and apparently died a non-CNS death.
