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Washington University Experience | INFECTION | Viruses | PML (JC Virus) | PML - Granule Cell Neuronopathy | 1A0 Case 1 History - Copy
Case 1 History ---- The patient is a 77 year old man with a history of multiple malignancies including prostate cancer S/P prostatectomy, transitional cell carcinoma S/P cystectomy and urostomy placement (2009-2010), lung cancer S/P partial lobectomy (2010), and mantle cell lymphoma S/P rituximab and bendamustine (2010-2011). He was admitted to the neurology service in October 2014 with a several-month history of worsening unsteadiness and ataxia. His workup demonstrated JCV neuronopathy by CSF PCR (increased JCV copies >800) and cerebellar biopsy with immunohistochemical demonstration of the JC virus. Inpatient treatment with plasma exchange, intravenous immunoglobulin, and high dose methylprednisolone resulted in symptomatic improvement. He was discharged in November 2014 and began receiving weekly interleukin 7 (IL-7) injections, resulting in clinical improvement which unfortunately proved transient when symptoms returned one month after his final dose. The recurrence of his symptoms was attributed to Immune Reconstitution Inflammatory Syndrome (IRIS), and he was readmitted 12/2014 and treated with high dose steroids (methylprednisolone), mirtazapine, and mefloquine. Over the following year, he exhibited a waxing/waning pattern of symptom severity with an overall trend of gradual health decline. However, his health began precipitously deteriorating in February 2016, when he was hospitalized for gallbladder necrosis requiring surgical intervention that was complicated by intra-abdominal sepsis and antibiotic-induced acute renal failure. Toward the end of his nearly two-month hospital stay, he began developing weakness of the right leg. After discharge in 03/2016, the weakness began steadily worsening, eventually progressed into a right hemiparesis, and ultimately advanced during the last few weeks of life into a state of weakness affecting the entire body and severely limiting his speech. He stopped eating and drinking and expired in hospice care.
