Progressive multifocal leukoencephalopathy in the clinical practice of a neurologist. Case report

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Abstract

Progressive multifocal leukoencephalopathy (PML) is an opportunistic infection with severe brain damage caused by the JC-virus, against the background of immunosuppressive conditions. The diagnosis of PML is complex and includes: the clinical picture, neuroimaging data, the presence of JC-virus DNA in samples of cerebrospinal fluid or brain tissue. HIV-associated PML is difficult to diagnose. In patients with multiple sclerosis, an increase in the incidence of PML is associated with the use of natalizumab. Increasing alertness towards the development and detection of PML makes it possible to achieve a favorable outcome.

About the authors

Yuliana A. Belova

Vladimirsky Moscow Regional Research Clinical Institute

Email: kotovsv@yandex.ru
ORCID iD: 0000-0003-1509-9608

Cand. Sci. (Med.)

Russian Federation, Moscow

Sergey V. Kotov

Vladimirsky Moscow Regional Research Clinical Institute

Author for correspondence.
Email: kotovsv@yandex.ru
ORCID iD: 0000-0002-8706-7317

D. Sci. (Med.), Prof.

Russian Federation, Moscow

References

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2. Fig. 1. MRI of the brain of patient K. The images were obtained in the axial and sagittal planes before and after contrast enhancement: a–c – in T2VI, FLAIR modes; d, e – in T1 mode. Pathological signal zones in the stem structures are visualized: the bridge, the right half of the medulla oblongata, with a transition along the right middle leg cerebellum in the upper half of the right hemisphere of the cerebellum, without clear contours and boundaries, irregular shape, single- nightly heterogeneous foci in the subcortical sections of the white matter of the large hemispheres, hyperintensive in T2VI and FLAIR modes. There is no accumulation of contrast media.

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3. Fig. 2. MRI of the brain of patient Z. 12 months before NTZ-PML. The study was carried out on a high-field apparatus with 3 Tesla magnetic field induction. The images were obtained in the axial and sagittal planes before and after contrast enhancement: a, b – in T2VI, FLAIR modes; c, d – in T1VI mode. MRI is a picture of a multi-focal lesion of the brain substance with supratentorial and infratentorial localization of foci, with involvement of the corpus callosum in the process , without signs of BBB violation.

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4. Fig. 3. MRI of the brain of patient Z. with a confirmed diagnosis of NCM-PML. The study was carried out on a high-field apparatus with 3 Tesla magnetic field induction. The images in the axial and sagittal planes before and after contrast enhancement are presented: a–c – in modes T2VI, FLAIR; d, e – in T1VI mode. MRI is a picture of a multi-focal lesion of the brain substance of supratentorial and infratentorial localization, with involvement in the process corpus callosum, without signs of BBB violation. In comparison with the previous study of the brain, the phenomenon of two large foci in the right sections of the medulla oblongata and the Varolian bridge and two diffuse zones in the subcortical sections of the temporo-occipital regions of both hemispheres of the large brain, which do not accumulate contrast material, was found.

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