Progressive multifocal leukoencephalopathy in patients with chronic kidney disease

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Jennifer Meylor1, Daniel Crespo Artunduaga1, Michael Mendoza1

  • 1Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.

Neurological Sciences : Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
|November 10, 2023
PubMed

Insights

Progressive multifocal leukoencephalopathy (PML), a rare brain infection, can occur in older adults with chronic kidney disease (CKD). This case series highlights the importance of considering JC virus testing in patients with unexplained neurological decline, even without a known immunocompromised status.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Nephrology

Background:

  • Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system caused by the JC virus.
  • PML typically affects immunocompromised individuals, leading to rapid neurological decline.
  • Chronic kidney disease (CKD) can impair immune function, potentially increasing susceptibility to opportunistic infections.

Purpose of the Study:

  • To report two cases of PML in elderly patients with CKD.
  • To investigate the potential link between CKD and PML development.
  • To emphasize the importance of JC virus testing in specific patient populations.

Main Methods:

  • Case report of two older patients diagnosed with PML.
  • Review of clinical history, neurological symptoms, and diagnostic findings.
  • Analysis of the potential role of CKD-induced immunosuppression.

Main Results:

  • Both patients presented with rapid neurological decline.
  • PML diagnosis was confirmed in both individuals with underlying CKD.
  • CKD was identified as a potential contributing factor to their immunosuppressed state.

Conclusions:

  • PML can occur in older individuals with CKD, even without a previously recognized immunocompromised state.
  • JC virus testing should be considered in the differential diagnosis for unexplained neurological decline in CKD patients.
  • CKD-associated immune dysfunction may predispose individuals to PML.
Keywords:
Human polyomavirus JV virus (JCV)ImmunocompetentKidney diseaseProgressive multifocal leukoencephalopathy (PML)

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