title: Progressive multifocal leukoencephalopathy as the first manifestation of occult sarcoidosis: case report and review of the literature.
abstract: BACKGROUND
  Progressive multifocal leukoencephalopathy (PML), a demyelinating disease of the central nervous system, is caused by reactivation of the JC virus. This disease is typically seen in individuals with known immune suppression. It has also been associated with other inflammatory conditions, such as sarcoidosis.
  
  
  METHODS
  A 68-year-old woman without known immune suppression presented with mental status changes over several weeks. Brain biopsy and cerebrospinal fluid analysis led to the diagnosis of PML. On autopsy, she was found to have previously undiagnosed sarcoidosis.
  
  
  CONCLUSIONS
  To our knowledge, this is the first published case of PML as the first manifestation of sarcoidosis in the absence of inflammatory hematologic involvement.
authors.affiliation: Department of Neurology, University of Maryland Medical Center, Baltimore, MD 21201, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Davis
authors.forename: Adnan
authors.initials: A
authors.lastname: Khan
authors.forename: Walter
authors.initials: W
authors.lastname: Royal
mesh_terms: D000368:Aged; D015703:Antigens, CD / Q000378:metabolism; D015214:Antigens, Differentiation, Myelomonocytic / Q000378:metabolism; D001344:Autopsy; D002794:Choline / Q000378:metabolism; D003401:Creatine / Q000378:metabolism; D005260:Female; D006801:Humans; D007968:Leukoencephalopathy, Progressive Multifocal / Q000150:complications*; D008168:Lung / Q000473:pathology; D008198:Lymph Nodes / Q000473:pathology; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D009206:Myocardium / Q000473:pathology; D009778:Occipital Lobe / Q000378:metabolism / Q000473:pathology; D015835:Ocular Motility Disorders / Q000150:complications / Q000175:diagnosis / Q000209:etiology; D009842:Oligopeptides / Q000378:metabolism; D012507:Sarcoidosis / Q000150:complications / Q000175:diagnosis / Q000209:etiology; D013702:Temporal Lobe / Q000378:metabolism / Q000473:pathology; D000097382:CD68 Molecule
chemical_list: D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D002794:Choline; D003401:Creatine; D009842:Oligopeptides; C067980:CD68 antigen, human; D000097382:CD68 Molecule; C402304:SV40 nuclear localization peptide