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Progressive multifocal leukoencephalopathy in a patient with multiple myeloma

Masaru Akiyama1, Toru Takahashi, Sinjo Nomura

  • 1Department of Hematology, Tokuyama Central Hospital, 1-1 Koda, Shunan, Yamaguchi, Japan.

International Journal of Hematology
|May 28, 2010
PubMed

Insights

Progressive multifocal leukoencephalopathy (PML), a rare brain infection, occurred in an immunodeficient patient with multiple myeloma (MM). Early diagnosis is crucial for MM patients presenting with neurological symptoms.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Oncology

Background:

  • Progressive multifocal leukoencephalopathy (PML) is a rare, opportunistic demyelinating disease affecting the central nervous system.
  • PML primarily impacts individuals with compromised immune systems, including those with hematological malignancies like multiple myeloma (MM).

Observation:

  • A 64-year-old male diagnosed with IgD type multiple myeloma (MM) presented with progressive neurological deficits.
  • Brain MRI revealed a characteristic hyperintense, non-enhancing lesion in the left frontal lobe.
  • Cerebrospinal fluid analysis confirmed the presence of John Cunningham virus (JCV) DNA via polymerase chain reaction.

Findings:

  • Histopathological examination of autopsy brain tissue demonstrated JCV DNA within the nuclei of oligodendroglia, confirming PML.
  • The case highlights a rare occurrence of PML in the context of multiple myeloma.

Implications:

  • This case underscores the importance of considering PML in multiple myeloma patients exhibiting neurological symptoms.
  • Prompt diagnostic workup, including JCV DNA testing and neuroimaging, is recommended for early detection and management.
  • Raising awareness of PML as a potential complication in MM patients can lead to improved patient outcomes.

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