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Diffuse large B cell lymphoma secondary to JC virus in progressive multifocal leukoencephalopathy

Ashwin Reddi1, Nikhil Patel2, Nicholas A Morris3

  • 1School of Medicine, University of Maryland, Baltimore, MD, USA.

Journal of Neurovirology
|May 30, 2019
PubMed

Insights

A patient with HIV and progressive multifocal leukoencephalopathy (PML) initially suspected to have PML-IRIS was diagnosed with diffuse large B cell lymphoma. JC virus infection may predispose individuals to central nervous system lymphomas.

Area of Science:

  • Neuro-oncology
  • Infectious Diseases
  • Hematology

Background:

  • Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease caused by the JC virus.
  • Human Immunodeficiency Virus (HIV) infection is a significant risk factor for PML.
  • Immune reconstitution inflammatory syndrome (IRIS) can complicate PML treatment.

Observation:

  • A 43-year-old male with HIV, recently initiated HAART, and existing PML presented with altered mental status.
  • Initial clinical presentation suggested PML-IRIS.
  • Neuroimaging findings prompted further investigation.

Findings:

  • Cerebrospinal fluid analysis via flow cytometry revealed diffuse large B cell lymphoma (DLBCL).
  • JC virus may play an oncogenic role in the development of CNS lymphomas, similar to Epstein-Barr virus (EBV).
  • PML cases associated with JC virus can be linked to secondary malignancies.

Implications:

  • This case highlights the importance of considering secondary CNS malignancies in HIV patients with PML, especially when clinical presentation is atypical for PML-IRIS.
  • JC virus's potential oncogenic role warrants further investigation in the pathogenesis of CNS lymphomas.
  • Accurate diagnosis through methods like flow cytometry is crucial for appropriate treatment of co-occurring conditions in immunocompromised patients.

Keywords:
Diffuse large B cell lymphomaEBVIRISJC virusMalignancyPML

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