An Unusual Case of Progressive Multifocal Leukoencephalopathy in a Patient with Non-traditional Risk Factors

Liebowitz JE Zeiger W
2015 Journal of Neurological Disorders  
Case Report Mr. A is a 52 year old man from Qatar with a past medical history of hypertension, diabetes mellitus type 2, hyperlipidemia, diverticulitis status post hemicolectomy, and cervical stenosis of C5-7 who began experiencing intermittent headaches, episodes of slurred speech, and decreased appetite from April to October 2014. In November 2014, he developed progressive weakness of his right lower extremity over three days, to the extent that he was unable to control his right lower
more » ... right lower extremity or walk properly. The weakness was associated with intermittent leg pain as well as numbness in both feet. He had no associated bowel or bladder symptoms. He presented to the emergency department of a local institution where an MRI of the brain demonstrated focal atrophy of the left post central and adjacent superior frontal gyri at the vertex with mild white matter T2 hyperintensity. His symptoms persisted and he was transferred to a higher level of care for further evaluation. During that admission he developed he developed new onset right upper extremity weakness in addition to his right lower extremity weakness. The following day, he experienced a focal motor seizure of the right upper and lower extremities. Phenytoin was prescribed and after he had a second seizure and levetiracetam was later added. Repeat MRI of the brain with and without contrast showed a non-enhancing T2 hyperintense lesion involving the left posterior frontal and parietal preand post-central gyri without significant mass effect. Unfortunately, the patient experienced multiple recurrent focal seizures that were resistant to multiple anti-epileptics and was intubated due to declining level of consciousness. A third MRI of the brain showed increased size of the left frontoparietal lesion and expansion into the occipital cortical and subcortical regions, with mild increase in mass effect, and intralesional dark foci on susceptibility weighted imaging concerning for petechial hemorrhage. Viral and bacterial cultures from the patient's cerebrospinal fluid (CSF) showed no growth. The patient was then transferred to our institution for further diagnostic evaluation. Shortly after arrival, the patient underwent repeat lumbar puncture. CSF analysis was notable for positive JC virus polymerase chain reaction. To make a more definitive diagnosis, brain biopsy Abstract *Corresponding author:
doi:10.4172/2329-6895.1000247 fatcat:6epef2ggcng7bn5hskjp5i6vv4