The most accurate diagnosis of clinically suspected progressive multifocal leukoencephalopathy (PML) is made by neuronavigated needle brain biopsy and microscopic examination of the specimen confirming typical morphological features of the disease and, additionally, using immunohistochemistry (IHC) for detection of early viral proteins of the etiologic agent - polyoma virus JC (JCV). Due to the small biopsy volume, this approach can sometimes fail to confirm the clinical diagnosis of PML, as demonstrated by the presented clinical case. To check the reliability of using only IHC, we additionally tested 6 archival cases from our institute using IHC, in-situ hybridization (ISH) and real-time polymerase chain reaction (PCR). In the presented case, both biopsy and autopsy material were tested, in three archival cases only biopsy material and in the remaining cases post-mortem brain tissue was available. IHC (Anti-SV40 T antigen, mAb Pab416) was negative in 3 samples, in another 3 fewer than 10 cells per one ×20 microscopic field were positive. In our study, ISH proved to be a more sensitive method for JCV detection than IHC, being positive in all cases. Out of 7 tested specimens, realtime PCR failed to confirm the presence of JCV in 1 specimen, which was the oldest brain autopsy of an AIDS patient. Our study demonstrated that, especially when confronted with borderline clinical suspicion of PML and when only a small biopsy specimen is available, a combination of at least two different methods for JCV detection should be considered, preferably IHC with one of the available molecular methods.

Cutaneous leukocytoclastic vasculitis (LCV) is a histopathological term used to refer to in lammation of the small vessels, including arterioles, capillaries and postcapillary venules, in the skin. The main morphological features of LCV are fibrinoid necrosis of the vessel wall with mainly neutrophilic infiltration and leukocytoclasis. LCV can be idiopathic or triggered by several causes, such as medications, underlying infection and malignancies. IgA vasculitis is a type of LCV with IgA-dominant immune deposits in the vascular wall. We report a rare case of skin-limited IgA vasculitis a ter treatment with carboplatin in a patient with uterine cancer. To our knowledge, this is the first reported case of LCV (in our case, skin-limited IgA vasculitis) connected to carboplatin treatment. A 57-year-old patient with uterine carcinoma was treated with surgery. A terwards, she received postoperative chemotherapy with pegylated liposomal doxorubicin (PLD) in combination with carboplatin. When the disease progressed, the patient received carboplatin monotherapy; a ter the third round of carboplatin therapy, she developed IgA vasculitis of the skin without systemic involvement. Chemotherapy with carboplatin was discontinued. She was treated symptomatically, and a ter six months, the skin lesions resolved and had not reappeared as of her last visit. Carboplatin can induce LCV, and clinicians should be aware of this potential e fect for the proper management of a fected patients.

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