title: Progressive multifocal leukoencephalopathy mimicking cerebral vasculitis in systemic granulomatosis.
abstract: We describe the case of a 69-year-old man with systemic granulomatosis who presented with left-sided hemiplegia. Initial diagnosis concerning the neurological troubles was cerebral vasculitis. Corticosteroids associated with antituberculosis therapy showed a rapid but transient amelioration followed by neurological aggravation. Two weeks later, JC virus was detected in cerebrospinal fluid by PCR and the diagnosis of progressive multifocal leukoencephalopathy (PML) was made. Treatment with cytarabine and cidofovir was initiated but the patient died three months after the first neurological signs. In the presence of central neurological symptoms occurring during systemic granulomatosis before specific therapy, PML should be evoked.
authors.affiliation: Department of Infectious Diseases, Université Pierre et Marie Curie, APHP, Service de Maladies Infectieuses et Tropicales, Groupe Hospitalier Pitié-Salpétrière, 47-83, boulevard de l'Hôpital, 75651 Paris Cedex 13, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Terrier
authors.forename: Valérie
authors.initials: V
authors.lastname: Martinez
authors.forename: Danielle
authors.initials: D
authors.lastname: Seilhean
authors.forename: Catherine
authors.initials: C
authors.lastname: Chapelon-Abric
authors.forename: Parissa
authors.initials: P
authors.lastname: Vaghefi
authors.forename: Marc
authors.initials: M
authors.lastname: Sanson
authors.forename: François
authors.initials: F
authors.lastname: Bricaire
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Piette
authors.forename: Eric
authors.initials: E
authors.lastname: Caumes
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002555:Cerebrospinal Fluid / Q000821:virology; D000077404:Cidofovir; D003561:Cytarabine / Q000627:therapeutic use; D003596:Cytosine / Q000031:analogs & derivatives / Q000627:therapeutic use; D004279:DNA, Viral / Q000235:genetics / Q000302:isolation & purification; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D006429:Hemiplegia; D006801:Humans; D007577:JC Virus / Q000235:genetics / Q000302:isolation & purification; D007968:Leukoencephalopathy, Progressive Multifocal / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D063065:Organophosphonates / Q000627:therapeutic use; D016133:Polymerase Chain Reaction; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy; D020293:Vasculitis, Central Nervous System / Q000175:diagnosis*
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D004279:DNA, Viral; D063065:Organophosphonates; D003561:Cytarabine; D003596:Cytosine; D000077404:Cidofovir