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[Progressive multifocal leukoencephalopathy. Contribution of nuclear magnetic resonance imaging]
D Strubel1, F Kuntzmann, G Kieffer
1Service de Médecine-Interne Gériatrie, Hôpital de la Robertsau, Strasbourg.
Abstract:
Progressive multifocal leucoencephalopathy is a white matter infection caused by a papovavirus. Immunocompromised patients are predominantly affected. We report the case of a 74-year old woman with abdominal lymphoma resistant to chemotherapy. The diagnosis was suggested by cerebral CT and NMR images and was confirmed at postmortem pathological examination. The contribution of complementary examinations to the diagnosis is discussed in the light of recently published studies.
Insights
Progressive multifocal leukoencephalopathy (PML) is a rare brain infection affecting immunocompromised individuals. This case highlights diagnostic challenges and confirms PML in a patient with chemotherapy-resistant lymphoma.
Area of Science:
- Neurology
- Infectious Diseases
- Oncology
Background:
- Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system.
- PML is caused by the JC virus (a polyomavirus or papovavirus) and primarily affects immunocompromised patients.
- Patients with hematologic malignancies, including lymphoma, are at increased risk.
Observation:
- A 74-year-old woman with abdominal lymphoma, refractory to chemotherapy, presented with neurological symptoms.
- Cerebral computed tomography (CT) and nuclear magnetic resonance (NMR) imaging suggested PML.
- The diagnosis was definitively confirmed by postmortem pathological examination.
Findings:
- The case illustrates the diagnostic utility of neuroimaging in identifying PML in immunocompromised patients.
- Chemotherapy-resistant lymphoma was the underlying condition predisposing the patient to PML.
- Postmortem examination provided definitive pathological confirmation of PML.
Implications:
- Early and accurate diagnosis of PML is crucial for patient management, although treatment options are limited.
- Understanding the contribution of various diagnostic modalities can improve PML detection in at-risk populations.
- This case underscores the importance of considering opportunistic infections like PML in immunocompromised patients with neurological deficits.