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Case report: rare progressive cavitary lesion in progressive multifocal leukoencephalopathy
1Department of Internal Medicine, University Hospitals Geauga Medical Center, 13207 Ravenna Rd, Chardon, OH, 44024, USA. mindy.hoang@uhhospitals.org.
Journal of Neurovirology
|July 29, 2026
Summary
This case report details a rare progressive cavitary lesion in progressive multifocal leukoencephalopathy (PML), a central nervous system disease caused by John Cunningham (JC) virus reactivation. This finding correlates with rapid cognitive decline.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Progressive multifocal leukoencephalopathy (PML) is a rare, opportunistic demyelinating disease of the central nervous system.
- PML is caused by the reactivation of John Cunningham (JC) virus in immunocompromised individuals.
- Immunosuppression is often associated with conditions like microscopic polyangiitis, treated with agents such as cyclophosphamide, mycophenolate, and prednisone.
Purpose of the Study:
- To report an extremely rare case of progressive cavitary lesions in PML.
- To highlight the association between cavitary lesions and aggressive neurocognitive decline in PML.
- To contribute to the limited literature on this specific PML manifestation.
Main Methods:
- Case report of a 63-year-old male with microscopic polyangiitis on immunosuppressive therapy.
- Magnetic resonance imaging (MRI) to track lesion progression.
- Cerebrospinal fluid (CSF) analysis for JC virus detection.
- Stereotactic brain biopsy with histological staining and immunohistochemistry for diagnosis confirmation.
Main Results:
- The patient presented with stroke-like symptoms.
- MRI revealed a multifocal frontal lobe lesion that evolved into a cavitary lesion.
- PML diagnosis was confirmed by imaging, positive JC virus in CSF, and biopsy.
- Cavitary lesions in PML are exceptionally rare, with only one prior case documented.
Conclusions:
- Cavitary lesions represent an extremely rare but potential complication of PML.
- This manifestation appears linked to rapid neurocognitive deterioration.
- Further research is needed to understand the mechanisms and implications of cavitary PML.
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