International Journal of Case Reports and Images - IJCRI - Case Reports, Case Series, Case in Images, Clinical Images

   
Case Report
 
An interesting presentation of progressive multifocal leukoencephalopathy in apparently immunocompetent individual
Doungporn Ruthirago1, Parunyou Julayanont1, Jongyeol Kim2
1MD, Resident Physician, Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, Texas.
2MD, Associate Professor, Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, Texas.

doi:10.5348/ijcri-201604-CR-10591

Address correspondence to:
Doungporn Ruthirago
3601 4th Street, Lubbock, TX
USA 79430

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How to cite this article
Ruthirago D, Julayanont P, Kim J. An interesting presentation of progressive multifocal leukoencephalopathy in apparently immunocompetent individual. Int J Case Rep Images 2016;7(1):18–24.


Abstract
Introduction: Progressive multifocal leukoencephalopathy (PML) is a very uncommon disease in immunocompetent individual. There are only rare case reports of PML in immunocompetent hosts over the past 15 years. Almost all presented with neurological deficits that progressed over a few months to years. Frontal lobe-related behavioral change is an uncommon presentation and the rapid progression within two weeks has never been reported.
Case Report: We report a 64-year-old immunocompetent male who developed progressive perseveration, less interaction, and mutism within two weeks. Neurological examination did not show apparent weakness or sensory deficit. He underwent computed tomography scan of brain, magnetic resonance imaging scans of brain and whole spine, cerebrospinal fluid analyses, and stereotactic brain biopsy. Neoplasms, demyelinating diseases, and infections were on differential list. Brain biopsy confirmed the diagnosis of PML. His clinical condition was stable after the biopsy. After discussion about prognosis, the patient decided on palliative management.
Conclusion: There are various manifestations of PML which depend on the location of lesions. Either subacute neurologic deficits or behavioral change are possible presentations. The compatible appearances on imaging and high degree of clinical suspicion are essential for diagnosis, regardless of immune status. Brain biopsy is the gold standard for diagnosis.

Keywords: Brain biopsy, Behavior change, Immunocompetent, Progressive multifocal leukoencephalopathy (PML)


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Author Contributions
Doungporn Ruthirago – Substantial contribution to conception and design, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Parunyou Julayanont – Substantial contribution to conception, Analysis and interpretation of data, Drafting the article, revising it critically for important intellectual content, Final approval of the version to be published
Jongyeol Kim – Substantial contribution to conception, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Doungporn Ruthirago et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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