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Progressive multifocal leukoencephalopathy presenting as multiple enhancing lesions on MRI: case report and
H B Newton1, M Makley, A P Slivka
1Department of Neurology, Ohio State University, Columbus, USA.
Abstract:
This report describes an immunocompetent patient with memory loss and motor abnormalities whose magnetic resonance images demonstrated multiple enhancing white matter lesions, including one that was cystic, suggestive of metastatic tumors or abscesses. Neuropathological evaluation at biopsy and subsequent autopsy revealed progressive multifocal leukoencephalopathy. Magnetic resonance evidence of enhancement and cystic changes are rare findings in progressive multifocal leukoencephalopathy, but should be considered in the differential diagnosis, especially in patients without evidence for primary malignancy or infection.
Insights
This case study highlights a rare presentation of progressive multifocal leukoencephalopathy (PML) in an immunocompetent patient. Enhanced MRI findings, including cystic lesions, mimicked tumors or abscesses, underscoring PML in differential diagnoses.
Area of Science:
- Neuroscience
- Neuropathology
- Radiology
Background:
- Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating disease affecting the central nervous system.
- Typically, PML occurs in severely immunocompromised individuals.
- Standard MRI findings in PML include non-enhancing white matter lesions.
Observation:
- An immunocompetent patient presented with memory loss and motor abnormalities.
- Magnetic resonance imaging (MRI) revealed multiple enhancing white matter lesions, with one cystic lesion.
- These findings were initially suggestive of metastatic tumors or abscesses.
Findings:
- Neuropathological evaluation via biopsy and autopsy confirmed progressive multifocal leukoencephalopathy (PML).
- The presence of enhancement and cystic changes on MRI are atypical for PML.
- This case demonstrates that PML can present with imaging characteristics mimicking other pathologies.
Implications:
- Radiologists and clinicians should consider PML in the differential diagnosis for enhancing white matter lesions, even in immunocompetent patients.
- Enhanced MRI findings and cystic changes, though rare, are possible in PML.
- This case expands the understanding of PML's diverse imaging spectrum and diagnostic challenges.