Table of Contents
Washington University Experience | INFECTION | Viruses | PML (JC Virus) | PML - IRIS | 5A0 Case 5 History
Case 5 History ---- This patient is a 68 year old female with a past medical history of refractory Hodgkin's lymphoma diagnosed in 2003, treated with a variety of chemotherapeutic agents over many years with numerous recurrences (currently Cytarabine + Bendamustine) and rheumatoid arthritis. She has a diffuse recurrence of Hodgkin's lymphoma with involvement above and below the diaphragm, spleen, lungs, and multiple bony sites. In 2015 she developed progressively worsening left arm and leg weakness. MRI demonstrated a Flair and T2 hyperintense white matter lesion thought most consistent with PML. The lesion was T1-hypointense but enhanced with contrast, a pattern seen in patients with PML and Immune Reconstitution Inflammatory Syndrome (IRIS). Biopsy demonstrated PML with marked inflammation thought secondary to a period of immune reconstitution. She was initiated on a 5 day course of IV methylprednisolone (5 g total course). Acyclovir and fluconazole were started for prophylaxis. After initiating IV methylprednisolone therapy, she experienced improvement in her left arm and leg muscle strength and tone. She was treated with a course of steroids and acyclovir without recurrence. The patient developed sequelae of parkinsonism, unsteadiness/dizziness and difficulty walking. Brain MRI in 2017 with/w/o contrast was performed which showed no findings suggestive of residual/recurrent PML.
