Progressive multifocal leukoencephalopathy in a patient with systemic lupus erythematosus: Clues to early diagnosis

•CNS manifestations in rheumatic patients should not be assumed to be autoimmune.•PML can occur even in minimally immunosuppressed patients with rheumatic disease.•Novel MRI sequences may be useful in differentiating causes of progressive lesions.•A compatible presentation should prompt assiduous te...

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Bibliographic Details
Published in:Journal of clinical neuroscience 2019-09, Vol.67, p.261-263
Main Authors: Law, Lai Yin, Tan, Irene, Prowse, Michael, Sean Riminton, D., Reddel, Stephen W.
Format: Article
Language:English
Subjects:
Cystic encephalomalacia
Diagnosis
MRI
Prognosis
Progressive multifocal leukoencephalopathy
Systemic lupus erythematosus
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Description
Summary:•CNS manifestations in rheumatic patients should not be assumed to be autoimmune.•PML can occur even in minimally immunosuppressed patients with rheumatic disease.•Novel MRI sequences may be useful in differentiating causes of progressive lesions.•A compatible presentation should prompt assiduous testing for JC virus DNA in CSF. A case of progressive multifocal leukoencephalopathy (PML) occurring on low dose immunosuppression for systemic lupus erythematosus (SLE) and Sjogren’s syndrome (SS) is presented. Neurologic changes in patients with SLE or SS should not be assumed to be a disease manifestation. Importantly, serious opportunistic infections such as PML can occur in minimally immunosuppressed rheumatic patients. Early diagnosis, facilitated by scrutiny of MRI findings, should trigger measures to reconstitute immunity in an otherwise fatal disease.
ISSN:0967-5868
1532-2653
DOI:10.1016/j.jocn.2019.06.030