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Progressive Multifocal Leukoencephalopathy Misdiagnosed as Neuropsychiatric Systemic Lupus Erythematosus With a

Hussein Algahtani1,2,3, Bader Shirah2, Leen Othman2,3

  • 1King Abdulaziz Medical City.

The Neurologist
|December 2, 2021
PubMed
Abstract

Insights

Progressive multifocal leukoencephalopathy (PML), a rare brain infection, can be mistaken for neuropsychiatric lupus. Early recognition of PML in immunosuppressed patients is crucial to prevent fatal outcomes.

Area of Science:

  • Neuroimmunology
  • Infectious Neurology

Background:

  • Progressive multifocal leukoencephalopathy (PML) is a rare, often fatal, central nervous system infection caused by John Cunningham polyomavirus reactivation.
  • PML affects immunosuppressed individuals and has a global prevalence.

Observation:

  • A rare case of PML was misdiagnosed as neuropsychiatric systemic lupus erythematosus (SLE).
  • Delayed diagnosis and subsequent cyclophosphamide therapy contributed to a catastrophic outcome.

Findings:

  • New-onset cognitive impairment and seizures in immunosuppressed patients with autoimmune disorders warrant investigation for PML.
  • Intensifying immunosuppression in suspected neuropsychiatric SLE cases should be deferred until PML is ruled out.

Implications:

  • Highlights the importance of considering PML in differential diagnoses for neurological changes in immunosuppressed patients.
  • Emphasizes the need for multidisciplinary collaboration in managing suspected neuropsychiatric SLE to ensure accurate diagnosis and timely treatment.

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