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[Progressive multifocal leukoencephalopathy in a patient with prolonged survival: a case report]

Aquiles Antonio-Valdiviezo1, Sergio Gómez-Rivera, Jorge Martínez-Torres

  • 1Unidad de Medicina Familiar 11, Instituto Mexicano del Seguro Social, Tapachula, Chiapas.

Revista Medica Del Instituto Mexicano Del Seguro Social
|February 27, 2009
PubMed
Abstract

Insights

Progressive multifocal leukoencephalopathy (PML), a rare brain disease caused by a papovavirus, presents with demyelination. This case highlights a rapid, severe presentation in a young adult, emphasizing the need for advanced imaging for diagnosis.

Area of Science:

  • Neurology
  • Neurovirology

Background:

  • Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system.
  • PML is caused by the human polyomavirus, a type of papovavirus.

Observation:

  • A 27-year-old female presented with acute neurological decline including malaise, pain, paresthesia, hyperthermia, and diaphoresis.
  • Neurological status rapidly worsened to quadriplegia, stupor, and seizures within 72 hours.
  • Initial diagnostics, including spinal fluid analysis and CT scans, were unremarkable, necessitating advanced neuroimaging.

Findings:

  • Magnetic Resonance Imaging (MRI) revealed white matter lesions in the brain hemispheres, corpus callosum, cerebellum, and brainstem.
  • Angiography-MRI showed increased hyperdense areas within the white matter.
  • Pathological diagnosis confirmed progressive multifocal leukoencephalopathy, with no underlying immunological disease identified.

Implications:

  • This case underscores the importance of MRI in diagnosing PML, especially when initial tests are inconclusive.
  • The rapid and severe presentation in a young adult highlights the varied clinical spectrum of PML.
  • Accurate diagnosis is crucial for patient management and understanding disease progression.

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