[Progressive multifocal leukoencephalopathy (PML) in chronic lymphatic leukemia (CLL). Review of the literature and...

Area of Science:

• Neuroscience
• Infectious Diseases
• Oncology

Background:

• Progressive multifocal leukoencephalopathy (PML) is a rare, fatal demyelinating disease of the central nervous system caused by the JC virus (JCV).
• PML is often associated with immunosuppression, particularly in patients with advanced HIV/AIDS and hematologic malignancies like chronic lymphatic leukemia (CLL).
• Therapeutic options for PML, especially in non-HIV patients, are limited, with a poor prognosis often reported in the literature.

Observation:

• This report details a case of a patient diagnosed with both CLL and PML.
• The patient presented with mild right-sided hemiparesis and motor function disturbances.
• Cerebrospinal fluid (CSF) analysis revealed JC virus DNA positivity via PCR, and MRI showed characteristic subcortical lesions.

Findings:

• The patient received cidofovir therapy, an antiviral agent showing initial promise in PML cases associated with AIDS.
• Following 16 months of treatment, the patient's clinical symptoms remained stable.
• Significant regression of PML-induced MRI lesions was observed, and JC virus DNA became undetectable in the CSF.

Implications:

• This case suggests that cidofovir may be a viable therapeutic option for PML in patients with CLL.
• The findings indicate potential for improved outcomes and disease control in this challenging patient population.
• Further research into antiviral therapies for PML in immunocompromised individuals beyond HIV is warranted.