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Updated: May 14, 2026
06:44
Isolation of Brain-infiltrating Leukocytes
Published on: June 13, 2011
Progressive multifocal leukoencephalopathy in an immunocompetent patient
Panos G Christakis1, Daniel Okin, Anita J Huttner
1Yale School of Medicine, New Haven, Connecticut, United States.
Journal of the Neurological Sciences
|February 5, 2013
Summary
Progressive multifocal leukoencephalopathy (PML) is rare in immunocompetent individuals. This case highlights a potential treatment approach using serotonin receptor targeting therapy, showing promising results in stabilizing the patient's condition.
Area of Science:
- Neuroimmunology
- Viral Neurology
Background:
- Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating disease of the central nervous system.
- PML is typically associated with profound cellular immunodeficiency.
- JC virus (JCV) is the causative agent of PML.
Observation:
- A 69-year-old immunocompetent male presented with subacute confusion, anxiety, and gait disturbance.
- Brain MRI showed extensive white matter abnormalities in the parieto-occipito-temporal regions.
- Cerebrospinal fluid (CSF) PCR confirmed JCV positivity, leading to a diagnosis of PML.
Findings:
- Despite being immunocompetent, the patient's PML diagnosis was confirmed via biopsy.
- Initiation of mirtazapine and mefloquine led to a 100-fold decrease in JCV DNA titre within six months.
- Clinical stabilization and neuroimaging improvement were observed one year post-treatment.
Implications:
- This case suggests PML can occur in immunocompetent individuals, challenging typical etiological assumptions.
- Serotonin receptor targeting therapy (mirtazapine) may represent a novel therapeutic strategy for PML.
- Further research is warranted to explore the efficacy of pharmacological interventions in PML management.
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