A Defying Case of Progressive Multifocal Leukoencephalopathy

Joao Oliverio Ribeiro, Joao Pinto Machado, Sara Macedo, Eurico Oliveira

Abstract: Progressive Multifocal Leukoencephalopathy is a diffuse demyelinating disease of the central nervous system, caused by infection by the JC virus, usually associated with immunosuppression. The authors present the case of a 78 years old male, that was brought to the emergency department due to a confusional state. On the emergency department a Brain Computed Tomography was performed, revealing Multiple cortical-subcortical and deep focal hypodensity areas in both hemysferes, associated with dimming of the grooves, of unknown nature, likely secondary. The patient was admitted and a Brain Magnetic Resonance Image was performed, and confirmed the previous results, even though it didn’t exclude the possibility of a demyelinating disease. Considering the likelihood of a Lymphoma, corthicoids where initiated, but failed to improve the Brain lesions, as confirmed by a second Brain Magnetic Resonance. The clinical status of the patient began to deteriorate, and the patient started to become lethargic and with dysphonia. A lumbar puncture was performed and found no neoplasic cells. Facing the images and fast evolution of the disease, the diagnosis of Progressive Multifocal Leukoencephalopathy was assumed.

Keywords: Progressive Multifocal Leukoencephalopathy, Brain lesions, Confusional State