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Isolated cerebellar progressive multifocal leukoencephalopathy after allogeneic bone marrow transplantation: focus on
Linda Mazzai1, Davide Facchinelli2, Carlo Borghero2
1Neuroradiology Unit, Department of Diagnostics, San Bortolo Hospital, Vicenza, Italy.
Insights
Progressive multifocal leukoencephalopathy (PML) can present atypically in patients with hematologic neoplasms. Early diagnosis of JC virus infection is crucial for potentially curable treatment.
Area of Science:
- Neuroscience
- Immunology
- Oncology
Background:
- Progressive multifocal leukoencephalopathy (PML) is an opportunistic infection caused by the JC virus in immunocompromised individuals.
- Typical PML imaging reveals multifocal, asymmetric supratentorial white matter lesions, primarily in parieto-occipital regions.
- Hematologic neoplasms and hematopoietic stem cell transplantation (HSCT) are significant risk factors for opportunistic infections like PML.
Observation:
- A 47-year-old patient with relapsed acute myeloid leukemia (AML) post-HSCT presented with visual impairment.
- Magnetic resonance imaging (MRI) identified an isolated cerebellar lesion without mass effect or enhancement.
- Cerebrospinal fluid (CSF) analysis ruled out common opportunistic infections and CNS leukemic involvement.
Findings:
- JC virus DNA was detected in the patient's CSF via polymerase chain reaction (PCR), confirming PML.
- The patient's presentation with an isolated cerebellar lesion was atypical for PML.
- The clinical and radiological scenario prompted suspicion for PML despite the unusual lesion location.
Implications:
- PML should be considered in the differential diagnosis of patients with hematologic neoplasms presenting with neurological symptoms and atypical imaging findings.
- An isolated cerebellar lesion in an immunocompromised patient warrants thorough investigation for PML.
- Prompt diagnosis and management of PML are critical due to its potential curability, especially in the context of hematologic malignancies.
Introduction:
Progressive multifocal leukoencephalopathy (PML) is caused by JC virus opportunistic infection in the setting of immunodeficiency. Typical imaging features are multifocal and asymmetric lesions within supratentorial subcortical white matter in parieto-occipital regions.
Case Description:
A 47-year-old patient experienced a relapse of acute myeloid leukemia 21 months after hematopoietic stem cell transplantation. He also had visual impairment and magnetic resonance imaging showed an isolated cerebellar lesion without mass effect or enhancement. Common opportunistic infections and leukemic central nervous system involvement were excluded by cerebrospinal fluid (CSF) analysis. Given the worsening clinical and radiologic scenario, PML was suspected, and CSF protein chain reaction analysis was positive for JC virus.
Conclusions:
Given its potential curability, PML should be thoroughly investigated in patients with hematologic neoplasms and atypical isolated cerebellar presentation.
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