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Progressive Multifocal Leukoencephalopathy after Three Consecutive Liver Transplantations.

F Ozdemir¹, V Ince¹, A Baskiran¹

¹Inonu University, Liver Transplantation Institute, Department of General Surgery, Malatya, Turkey.

International Journal of Organ Transplantation Medicine

|August 26, 2015

Summary

Progressive multifocal leukoencephalopathy (PML) is a rare brain infection in transplant patients. This case highlights a fatal outcome despite treatment for John Cunningham Virus (JCV) reactivation after multiple liver transplants.

Keywords:

Immunocompromised host JC virus Leukoencephalopathy Liver transplantation Viral load progressive multifocal

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Area of Science:

Neurovirology
Transplant Medicine
Immunosuppression

Background:

Progressive multifocal leukoencephalopathy (PML) is a rare but serious opportunistic infection caused by John Cunningham Virus (JCV) reactivation.
JCV reactivation and PML are primarily observed in severely immunocompromised individuals, particularly those undergoing solid organ transplantation.
PML following liver transplantation is exceptionally uncommon, with poor prognostic indicators including atypical imaging and high viral loads.

Observation:

A patient with a history of three liver transplants developed PML.
The patient presented with unexpected radiological findings and a high JCV DNA viral load in cerebrospinal fluid (CSF).

Findings:

Despite prompt initiation of cytarabine therapy and complete cessation of immunosuppressive drugs, the patient's condition deteriorated.
The patient succumbed to the infection, indicating limited treatment efficacy in this severe case.

Implications:

This case underscores the challenges in managing PML in multiply transplanted patients with high JCV viral loads.
Further research is needed to explore effective therapeutic strategies for JCV reactivation in immunocompromised patients.
The rarity of PML post-liver transplant warrants continued vigilance and investigation into risk factors and outcomes.