Leg weakness in a lung transplant patient

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Abstract

Progressive multifocal leukoencephalopathy (PML) is associated with JC polyomavirus (JCV) infection of central nervous system oligodendrocytes resulting in demyelinization and progressive focal neurologic deficits. Reactivation of dormant JCV occurs in the setting of immunosuppression, most commonly in patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) or hematological malignancies. PML has also been reported in solid organ transplant recipients. We report the case of a 61-year-old man after bilateral lung transplantation for chronic hypersensitivity pneumonitis who presented with leg weakness, cognitive decline, and expressive aphasia at 5 months post transplantation. Magnetic resonance imaging and brain biopsy were consistent with PML. Treatment attempt with cytarabine was unsuccessful, and immunomodulation resulted in recurrent grade A3 rejection. The difficulty of managing PML in lung transplant patients is highlighted by the lack of directed therapy and risk of graft rejection or failure with attempts at decreasing immunosuppression.

Original languageEnglish (US)
JournalTransplant Infectious Disease
Volume15
Issue number3
DOIs
StatePublished - Jun 2013

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Keywords

  • JC virus
  • Leg weakness
  • Lung transplant
  • PML
  • Progressive multifocal leukoencephalopathy

ASJC Scopus subject areas

  • Transplantation
  • Infectious Diseases

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