Progressive Multifocal Leukoencephalopathy Presenting as Primary CNS Malignancy in an Immunocompetent Patient

Progressive multifocal leukoencephalopathy (PML) is an infection caused by the John Cunningham virus (JCV), usually in an immunocompromised host. We present the case of a 74-year-old male who presented with a six-week history of progressive memory loss, episodic confusion, and aphasia. Cranial nerve...

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Bibliographic Details
Published inCurēus (Palo Alto, CA) Vol. 15; no. 9
Main Authors Truong, Rachel D, Vadlapatla, Vamshi K, Avgeropoulos, Nicholas G
Format Journal Article
LanguageEnglish
Published Palo Alto Cureus Inc 23.09.2023
Cureus
Subjects
Antibodies
Antigens
Aphasia
Biopsy
Blood
Case reports
Chronic illnesses
Disease
Encephalitis
Genetic testing
HIV
Human immunodeficiency virus
Immunocompetence
Immunology
Literature reviews
Lymphoma
Magnetic resonance imaging
Neurology
Oncology
Patients
Spectrum analysis
Staphylococcus infections
Viral infections
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Summary:Progressive multifocal leukoencephalopathy (PML) is an infection caused by the John Cunningham virus (JCV), usually in an immunocompromised host. We present the case of a 74-year-old male who presented with a six-week history of progressive memory loss, episodic confusion, and aphasia. Cranial nerve, motor, sensory, and coordination testing were unremarkable. Magnetic resonance imaging (MRI) of the brain and spectroscopy were concerning for primary CNS lymphoma vs. diffuse glioma. Microscopic examination after the patient underwent left frontal stereotactic brain biopsy was suggestive of a viral infection, and further testing with JCV DNA in-situ hybridization (ISH) confirmed the diagnosis of PML. The patient's condition started resolving without treatment. This case demonstrates, to our knowledge, the first known case of primary PML masquerading as CNS lymphoma in modern literature.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.45815