Progressive multifocal leukoencephalopathy as the first presentation of sarcoidosis

Recognition of progressive multifocal leukoencephalopathy (PML) in patients with an established primary neuroinflammatory condition can be clinically challenging. Delayed or incorrect diagnosis may worsen the course of the disease and result in an inaccurate prognosis. We present an unusual case of...

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Bibliographic Details
Published in:BMJ case reports 2020-08, Vol.13 (8), p.e232636
Main Authors: Elbadri, Maha, Plant, Gordon
Format: Article
Language:English
Subjects:
Biopsy
Blood cancer
Brain Diseases - complications
Brain Diseases - diagnosis
Case reports
Drug therapy
Encephalitis
Eye movements
Granulomas
Humans
Leukoencephalopathy, Progressive Multifocal - etiology
Lymphatic system
Magnetic Resonance Imaging
Male
Medical prognosis
Middle Aged
Patients
Rare Disease
Sarcoidosis
Sarcoidosis - complications
Sarcoidosis - diagnosis
Steroids
Viral infections
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Description
Summary:Recognition of progressive multifocal leukoencephalopathy (PML) in patients with an established primary neuroinflammatory condition can be clinically challenging. Delayed or incorrect diagnosis may worsen the course of the disease and result in an inaccurate prognosis. We present an unusual case of a patient with a rapid decline in visual acuity, positive serum ACE and extensive lymphadenopathy who was found to have progressive subcortical lesions and cerebrospinal fluid PCR positive for John Cunningham virus supporting a coincidental diagnosis of PML. The prognosis of PML is affected by the associated condition. Establishing the diagnosis is important for an exact prognosis of the primary condition but also to allow early discontinuation of immunomodulatory treatment. Sarcoidosis-associated PML might have a similar aggressive course to that seen when associated with haematological malignancies.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2019-232636