Progressive Multifocal Leukoencephalopathy in a Patient with Multifocal Neurological Manifestations Caused by Solitary Brainstem Involvement

A Japanese man in his 60s on medication for chronic lymphocytic leukemia presented with progressive, multifocal neurological manifestations. Magnetic resonance imaging showed a small, solitary region of brainstem involvement. Sensitive real-time polymerase chain reaction testing detected a small amo...

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Bibliographic Details
Published in:Internal Medicine 2023/03/01, Vol.62(5), pp.787-792
Main Authors: Funatsu, Akito, Nakamichi, Kazuo, Araki, Midori, Fukumoto, Tetsuya, Mine, Hideki
Format: Article
Language:English
Subjects:
Brain Stem
brainstem
Case Report
Cerebrospinal fluid
Chronic lymphocytic leukemia
DNA viruses
DNA, Viral - genetics
Humans
Internal medicine
JC Virus
lesion volume
Leukemia, Lymphocytic, Chronic, B-Cell
Leukoencephalopathy
Leukoencephalopathy, Progressive Multifocal - drug therapy
Lymphatic leukemia
Magnetic resonance imaging
Male
Malignancy
Progressive multifocal leukoencephalopathy
real-time polymerase chain reaction
solitary lesion
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Summary:A Japanese man in his 60s on medication for chronic lymphocytic leukemia presented with progressive, multifocal neurological manifestations. Magnetic resonance imaging showed a small, solitary region of brainstem involvement. Sensitive real-time polymerase chain reaction testing detected a small amount of JC virus (JCV) DNA (170 copies/mL) with pathogenic mutation in cerebrospinal fluid. We diagnosed the patient with progressive multifocal leukoencephalopathy (PML). The small PML lesion may have caused multifocal neurological symptoms because of its focal brainstem involvement. This case contributes to knowledge regarding the diagnosis and treatment of brainstem PML in the context of hematologic malignancies and other underlying diseases.
ISSN:0918-2918
1349-7235
DOI:10.2169/internalmedicine.9627-22