Progressive multifocal leukoencephalopathy mimicking cerebral vasculitis in systemic granulomatosis.
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.
Terrier
Benjamin
B
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.
Martinez
Valérie
V
Seilhean
Danielle
D
Chapelon-Abric
Catherine
C
Vaghefi
Parissa
P
Sanson
Marc
M
Bricaire
François
F
Piette
Jean-Charles
JC
Caumes
Eric
E
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*
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D004279:DNA, Viral; D063065:Organophosphonates; D003561:Cytarabine; D003596:Cytosine; D000077404:Cidofovir