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Two cases of progressive multifocal leukoencephalopathy after renal transplantation
Abstract:
Progressive multifocal leukoencephalopathy (PML) occurred in two patients after kidney transplantation. Less than 2 years after such a transplantation associated with immunosuppressive chemotherapy a 54-year-old male developed polyneuropathy then clinical diffuse alteration of the central nervous system. He died three months later with the suspicion of hypertensive encephalopathy due to progressive renal failure. A 45-year-old female had a kidney transplantation first rapidly complicated by Listeria monocytogenes meningoencephalitis. She was cured from this disease and had a satisfactory social rehabilitation during two years. Afterwards, she suffered various neurological troubles, including epilepsy, that were attributed to combined renal failure and developing hydrocephalus. One year after the onset of these neurological symptoms, the grafted kidney was removed and chemotherapy was discontinued. She died three months later. Both patients had typical PML with eosinophilic intranuclear inclusions in presumptive oligodendroglial cells. By electron microscopy, performed on formalin fixed brain tissue, round particles (40-50 nm) could be recognized in some glial cell nuclei. These two cases are confronted with the four published observations of PML following organ transplantation.
Insights
Two kidney transplant patients developed progressive multifocal leukoencephalopathy (PML) after immunosuppressive therapy. This rare neurological condition, linked to JC virus reactivation, highlights risks in transplant recipients.
Area of Science:
- Neurology
- Immunology
- Transplantation Medicine
Background:
- Organ transplantation, particularly kidney transplants, often requires immunosuppressive chemotherapy to prevent rejection.
- Immunosuppression can increase the risk of opportunistic infections and viral reactivations.
- Progressive multifocal leukoencephalopathy (PML) is a rare, demyelinating disease of the central nervous system caused by the JC virus.
Observation:
- Two kidney transplant recipients developed progressive multifocal leukoencephalopathy (PML) following immunosuppressive therapy.
- Clinical presentations included polyneuropathy, diffuse central nervous system alterations, and epilepsy.
- Histopathological examination revealed characteristic PML findings, including intranuclear inclusions in oligodendrocytes.
Findings:
- Both patients exhibited typical PML pathology, confirmed by electron microscopy showing viral particles within glial cell nuclei.
- The cases suggest a potential association between kidney transplantation, immunosuppression, and the development of PML.
- These findings are compared with four previously reported cases of PML post-organ transplantation.
Implications:
- The study underscores the importance of monitoring for rare neurological complications like PML in immunosuppressed transplant patients.
- Early recognition and potential management strategies for PML in this population warrant further investigation.
- This research contributes to understanding the spectrum of neurological risks associated with organ transplantation and immunosuppressive regimens.