SHM Converge Scientific Abstract ePoster Gallery-Unusual Host: Progressive Multifocal Leukoencephalopathy in a Patient With Cirrhosis

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This case describes a 73-year-old man with cirrhosis and hepatocellular carcinoma who developed two weeks of progressive difficulty performing tasks, including word-finding problems, impaired attention and memory, trouble following commands, and a right pronator drift. He had no fever, headache, weakness, sensory loss, or vision changes. Initial labs were largely normal except for mildly elevated ammonia. Extensive serum and CSF testing for infectious, inflammatory, and malignant causes was unrevealing. CT head showed bilateral parietal vasogenic edema, and MRI demonstrated non-enhancing T2/FLAIR hyperintense white matter lesions in the bilateral parietal and left occipitotemporal regions, suggesting a demyelinating process.<br /><br />He was treated empirically for hepatic encephalopathy with lactulose and for inflammatory demyelination with high-dose methylprednisolone, but his neurologic status did not improve. He was discharged without a diagnosis, then returned one week later with worsening confusion and inability to perform activities of daily living. JC virus PCR later returned positive in serum and was confirmed in CSF on repeat lumbar puncture, establishing the diagnosis of progressive multifocal leukoencephalopathy (PML). His condition rapidly deteriorated, and he died six weeks after symptom onset.<br /><br />The discussion emphasizes that PML should be considered in patients with non-enhancing demyelinating white matter lesions, even without obvious immunosuppression. Cirrhosis may confer immune dysfunction through hypogammaglobulinemia and leukopenia from splenic sequestration. Because prognosis is poor and treatment options are limited in non-HIV PML, early recognition can help guide prognosis and, in select cases, prompt novel therapies.

Asset Subtitle

Eric Caliendo

Meta Tag

Author List Annie Massart, Eric Caliendo, Hang Shi

Category Clinical Vignettes

Concept Progressive Multifocal Leukoencephalopathy

Concept Demyelinating White Matter Lesion

Concept JC Virus

Concept JC Virus PCR

Concept Cognitive impairment

Distinguished Non-Finalist

Presenter Organization Emory University

Presenting Author Eric Caliendo

Track Adult

Keywords

progressive multifocal leukoencephalopathy

PML

JC virus

cirrhosis

hepatocellular carcinoma

demyelinating white matter lesions

vasogenic edema

cognitive decline

immunosuppression

MRI brain

Progressive Multifocal Leukoencephalopathy

Demyelinating White Matter Lesion

JC Virus

JC Virus PCR

Cognitive impairment