title: Progressive Multifocal Leukoencephalopathy in a Lung Transplant Recipient: Isolation of John Cunningham (JC) Virus from Bronchoalveolar Lavage.
abstract: Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system caused by polyomavirus John Cunningham (JC) virus. We report the case of a 60-year-old woman who presented 16 months after right single lung transplant with worsening memory, behavioral problems, emotional lability, and progressive left upper extremity weakness. Magnetic resonance imaging revealed white matter changes suggestive of PML. JC virus infection was confirmed with polymerase chain reaction (PCR) from both the bronchoalveolar lavage (BAL) fluid and cerebrospinal fluid. To our knowledge, this is the first report of PCR isolation of JC virus from a BAL specimen. We also review the two additional cases in the literature that describe PML after lung transplantation. JC virus infection should be considered in the differential diagnosis of lung transplant recipients who develop neurological symptoms. BAL may have a role in the etiologic diagnosis of PML after lung transplantation.
authors.affiliation: John and Doris Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
authors.forename: Tanmay S
authors.initials: TS
authors.lastname: Panchabhai
authors.affiliation: Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Chirag
authors.initials: C
authors.lastname: Choudhary
authors.affiliation: Department of Infectious Diseases, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Carlos
authors.initials: C
authors.lastname: Isada
authors.affiliation: Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Erik
authors.initials: E
authors.lastname: Folch
authors.affiliation: Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Atul C
authors.initials: AC
authors.lastname: Mehta
keywords: Acquired immunodeficiency syndrome; John Cunningham virus; lung transplant; progressive multifocal leukoencephalopathy