A case report of progressive multifocal leukoencephalopathy in a human T-cell lymphotropic virus type 1-infected hemodialytic patient

Hiroto Matsuda, Koichi Hayashi, Mariko Meguro, Takao Saruta

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

We experienced a case manifesting progressive multifocal leukoencephalopathy (PML) in a hemodialytic patient with hepatitis C virus-induced liver cirrhosis and human T-cell lymphotropic virus type-1 (HTLV-1)-associated uveitis. A 57-year-old male patient had received chronic hemodialysis therapy for 10 years, during which he received multiple blood transfusions and HTLV-1-associated uveitis developed. He complained of visual disturbance and disorientation. Brain CT scan showed diffuse and multifocal low density areas in occipital and temporal lobes, with gray matter relatively spared. MRI imaging showed high intensity lesions in the same areas. Cerebrospinal fluid culture was negative, but using nested PCR, rearranged regulatory region of JC virus DNA was detected. His consciousness level gradually deteriorated and complete paraplegia developed. Seven months after admission, he died of pneumonia. An autopsy confirmed the diagnosis of PML. Notably, mononuclear cell infiltration, gliosis and demyelinating lesions but no nuclear inclusion bodies were observed in the thoracic cord, which suggested HTLV-1-associated myelopathy. Because JC virus is activated under immunocompromised conditions, precipitating factors in this case appear multifactorial; depressed immune system induced by chronic hemodialysis as well as blood-borne hepatitis C virus/HTLV-1 infection might contribute to the activation of dormant JC virus and the development of florid clinical manifestation of PML.

Original languageEnglish
Pages (from-to)291-295
Number of pages5
JournalTherapeutic Apheresis and Dialysis
Volume10
Issue number3
DOIs
Publication statusPublished - 2006 Jun

Fingerprint

Progressive Multifocal Leukoencephalopathy
Human T-lymphotropic virus 1
JC Virus
T-Lymphocytes
Uveitis
Hepacivirus
Renal Dialysis
Tropical Spastic Paraparesis
Intranuclear Inclusion Bodies
Precipitating Factors
Occipital Lobe
Confusion
Gliosis
Paraplegia
Nucleic Acid Regulatory Sequences
Virus Diseases
Temporal Lobe
Consciousness
Blood Transfusion
Liver Cirrhosis

Keywords

  • Hemodialysis
  • HTLV-1-associated myelopathy
  • JC virus
  • Liver cirrhosis
  • Progressive multifocal leukoencephalopathy

ASJC Scopus subject areas

  • Hematology
  • Nephrology

Cite this

A case report of progressive multifocal leukoencephalopathy in a human T-cell lymphotropic virus type 1-infected hemodialytic patient. / Matsuda, Hiroto; Hayashi, Koichi; Meguro, Mariko; Saruta, Takao.

In: Therapeutic Apheresis and Dialysis, Vol. 10, No. 3, 06.2006, p. 291-295.

Research output: Contribution to journalArticle

Matsuda, Hiroto ; Hayashi, Koichi ; Meguro, Mariko ; Saruta, Takao. / A case report of progressive multifocal leukoencephalopathy in a human T-cell lymphotropic virus type 1-infected hemodialytic patient. In: Therapeutic Apheresis and Dialysis. 2006 ; Vol. 10, No. 3. pp. 291-295.
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