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Case report: rare progressive cavitary lesion in progressive multifocal leukoencephalopathy

Mindy Hoang1, Richard Hc Lai2

  • 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
PubMed

Insights

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.
Keywords:
Cavitary lesionImmunosuppressedJC virusJohn cunningham virusPMLProgressive multifocal leukoencephalopathy

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