Progressive multifocal leucoencephalopathy associated with lupus and methotrexate overdose

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Analyses of Proteinuria, Renal Infiltration of Leukocytes, and Renal Deposition of Proteins in Lupus-prone MRL/lpr Mice

Published on: June 8, 2022

D Shprecher1, T Frech, S Chin

  • 1Department of Neurology, University of Rochester, Rochester, New York, USA. david_shprecher@urmc.rochester.edu

Lupus
|October 15, 2008
PubMed

Insights

Progressive multifocal leukoencephalopathy (PML), a rare JC virus CNS infection, can mimic lupus complications. Early diagnosis is crucial before immunosuppressive therapy for neuropsychiatric lupus.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Immunology

Background:

  • Systemic lupus erythematosus (SLE) can present with diverse neurological manifestations.
  • Neuropsychiatric lupus (NSLE) diagnosis can be challenging, often requiring exclusion of other conditions.
  • JC virus (JCV) causes Progressive Multifocal Leukoencephalopathy (PML), a rare but serious CNS demyelinating disease.

Observation:

  • A case of PML in a patient with SLE is presented.
  • The patient was receiving supra-therapeutic doses of methotrexate.
  • PML was initially considered in the differential diagnosis of the patient's neurological symptoms.

Findings:

  • PML, a CNS infection by JC virus, rarely occurs in lupus patients.
  • PML can be misdiagnosed as antiphospholipid antibody syndrome or NSLE.
  • The presented case highlights PML as a critical consideration in SLE patients with CNS symptoms.

Implications:

  • Central nervous system (CNS) infections must be considered before initiating immunosuppressants for NSLE.
  • Supra-therapeutic methotrexate doses may increase the risk of opportunistic infections like PML in SLE patients.
  • This case underscores the importance of vigilant diagnosis in SLE to differentiate infectious from autoimmune neurological conditions.

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