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[A case of progressive multifocal leukoencephalopathy with alcoholic liver dysfunction]

Yasuhiro Ono1, Yoichiro Kikuchi, Atsushi Katsumata

  • 1Department of Neurosurgery, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa, Japan.

No Shinkei Geka. Neurological Surgery
|June 15, 2010
PubMed

Insights

Progressive multifocal leukoencephalopathy (PML), a brain infection, was diagnosed in an immunocompromised patient with alcoholic liver dysfunction. This case highlights PML as a rare complication in patients with liver disease.

Area of Science:

  • Neuroscience
  • Infectious Diseases
  • Hepatology

Background:

  • Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system caused by JC virus.
  • PML typically affects immunosuppressed individuals, increasing its incidence in patients with conditions like acquired immunodeficiency syndrome (AIDS).

Observation:

  • A 59-year-old man with a history of alcoholic liver dysfunction presented with progressive left leg weakness.
  • MRI revealed multiple white matter lesions characteristic of PML, including T1 low and T2 high intensities.
  • Biopsy confirmed demyelination and oligodendroglial nuclear enlargement, with electron microscopy showing JC virus particles.

Findings:

  • JC virus infection in the central nervous system was confirmed via polymerase chain reaction (PCR) on cerebrospinal fluid.
  • Histopathology and viral particle identification confirmed PML diagnosis.
  • The patient's immune-compromised state was linked to alcoholic liver dysfunction.

Implications:

  • This case represents the first documented instance of PML in an immunocompromised individual with alcoholic liver dysfunction.
  • Highlights the importance of considering PML in immunocompromised patients presenting with neurological deficits, even with underlying liver disease.
  • Suggests alcoholic liver dysfunction can contribute to an immunocompromised state susceptible to opportunistic infections like PML.

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