Successful Outcome of Progressive Multifocal Leukoencephalopathy in a Renal Transplant Patient

Abstract

We report the case of a 47-year-old man who developed progressive multifocal leukoencephalopathy (PML) after receiving immuno-suppressive therapy for renal transplantation. The patient presented with a focal seizure and cognitive changes 5 months posttransplantation. He was found to have enhancing lesions in the parietal lobe and typical findings of PML in a brain biopsy. Immunosuppression was discontinued and the neurological symptoms gradually resolved over a period of 4 weeks. The patient is free of any neurological symptoms 36 months after the diagnosis of PML and imaging studies demonstrate resolution of the PML lesions. The patient returned to hemodialysis 3 months after immunosuppression was discontinued. We also present a review of the literature on PML in renal transplant recipients.

Viral infection and reactivation in autoimmune disease

“…JCV is neurotropic, and reactivation can lead to progressive multifocal leukoencephalopathy (PML), a fatal demyelinating condition. The occurrence of PML is restricted to patients with primary or secondary immunosuppression; it has been reported, for example, in recipients of heart, kidney, or liver transplants (61)(62)(63)(64).…”

The human JC polyomavirus (JCPyV): virological background and clinical implications

“…For transplant patients, this approach requires reduction in immunosuppressive treatment, which is limited by immune reactions causing graft rejection and loss of organ functions. In the case of kidney transplantation, return to hemodialysis remains a viable option, and discontinuation of immunosuppression may be indicated for a successful outcome (214). In the case of SOT without artificial organ substitution, reducing immunosuppression may not be feasible to allow for a timely recovery of JCPyV-specific immune control.…”

Effect of plasma exchange in accelerating natalizumab clearance and restoring leukocyte function

“…20,21 Immune reconstitution is the only intervention with demonstrated efficacy for PML, including patients with HIV infection taking highly active antiretroviral therapy 22,23 and in transplant patients after reduction in immunosuppressant medications. 24,25 Little is known about how to remove therapeutic proteins from the body and whether their removal will restore the native function of the endogenous targets. We evaluated the efficacy of plasma exchange (PLEX) in accelerating the clearance of natalizumab and the subsequent decrease in saturation of ␣4-integrin by comparing these measures after natalizumab infusion both with and without PLEX.…”