Table of Contents
Washington University Experience | INFECTION | Viruses | PML (JC Virus) | PML - Neurosarcoid vs PML Case | 0A0 Case 1 History
Treatment of Pulmonary Sarcoid Resulting in CNS PML ---- Case History ---- The patient was a 76 year-old man with history of coronary artery disease, type 2 diabetes mellitus, hypertension, hyperlipidemia, deep vein thrombosis and hypothyroidism who initially presented with recurrent bronchitis and peripheral neuropathy. In July 2020, chest X-ray showed pulmonary opacities and a biopsy showed non-necrotizing granulomas, suspicious for pulmonary sarcoidosis for which the decedent received a course of steroids. After finishing his course of steroids, he had worsening shortness of breath, vision loss, episodes of disorientation, confusion, and neurologic deficits and was admitted to an OSH in September. An MRI scan showed multiple FLAIR hyperintense white matter lesions. He was treated with high dose steroids and discharged with little, if any, improvement. On 11/3 he was admitted to an outside hospital with progressive encephalopathy with confusion, difficulty reading, falls and gait instability, left sided weakness, and additional neurological deficits and was again treated with high dose steroids with no clinical improvement. The decedent was transferred to BJH for further evaluation and management. A brain biopsy on 11/13 confirmed PML, although a JC virus CSF study was negative. The decedent continued to decompensate and had respiratory distress. His family voiced that aggressive management of his condition were not within the decedent's goals of care. He was transitioned to comfort care on 11/25 and passed away on 11/30.
