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Simultaneous Development of Progressive Multifocal Leukoencephalopathy and Cryptococcal Meningitis during

Yasunobu Nosaki1, Ken Ohyama1, Maki Watanabe1

  • 1Department of Neurology, Toyohashi Municipal Hospital, Japan.

Internal Medicine (Tokyo, Japan)
|September 19, 2019
PubMed

Insights

Progressive multifocal leukoencephalopathy (PML) and cryptococcal meningitis can occur together in immunosuppressed patients. Early recognition and treatment, including stopping immunosuppression, can lead to symptom improvement.

Area of Science:

  • Neuroimmunology
  • Infectious Diseases

Background:

  • Progressive multifocal leukoencephalopathy (PML) is a rare, fatal demyelinating disease of the central nervous system.
  • PML is caused by JC virus reactivation in immunocompromised individuals.
  • Immunosuppression is a significant risk factor for opportunistic infections like PML and cryptococcal meningitis.

Observation:

  • A 65-year-old woman with rheumatoid arthritis developed simultaneous PML and cryptococcal meningitis.
  • Her immunosuppression was due to methotrexate and infliximab treatment.
  • The patient presented with bilateral sixth nerve palsy.

Findings:

  • Concurrent PML and cryptococcal meningitis is a rare but serious complication in immunosuppressed patients.
  • Antifungal treatment and cessation of immunosuppressive therapy led to symptom improvement.
  • This case highlights the importance of considering multiple opportunistic infections in this patient population.

Implications:

  • Clinicians should maintain a high index of suspicion for concurrent PML and cryptococcal meningitis in immunosuppressed patients.
  • Prompt diagnosis and management, including immunosuppression withdrawal, are crucial for patient outcomes.
  • This case underscores the complex interplay between immunosuppression, viral reactivation, and fungal infections in the central nervous system.
Keywords:
JC viruscryptococcal meningitisinfliximabmethotrexateprogressive multifocal leukoencephalopathy

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