Abstract Details

Title Progressive Multifocal Leukoencephalopathy in immunocompetent a case report and review of literature

Topic General Neurology

Presentation(s) P12 - Poster Session 12 (5:30 PM-6:30 PM)

Poster/Presentation
Number 2-002

Background Progressive multifocal leukoencephalopathy, (PML) a demyelinating disease of the brain, caused by the John Cunningham (JC Virus) is usually seen in patients who are immunocompromised. Here, we describe a case of an immunocompetent patient diagnosed with PML and a comprehensive literature review.

Objective NA

Design/Methods

Case Description: A 64-year-old Caucasian male presented with acute worsening of progressive neurological decline with difficulty in vision and reading. The patient was diagnosed with Coronavirus disease 2019 (COVID-19). Following COVID-19 infection he started to have difficulty in maintaining balance, poor attention span and expressive aphasia.

Based on history, examination, CSF markers, histopathology, and T2/FLAIR MRI Brain at the time of presentation the patient was diagnosed with PML in a setting of no immunosuppression disorder.

Results

In our literature review, it was seen that the average age of symptom presentation was 57.5 with predominance in males. Most of the patients presented with progressive neurological deficits with symptomology ranging from mild confusion, aphasia, anxiety to sensory disturbances with numbness, hemiparesis and hemianopsia. Out of the 21 cases, patients responded to mirtazapine and intravenous pulse methylprednisolone (IVMP). The mortality rate was close to 50% with 11 fatal cases and 10 non-fatal cases. None of the cases had any immunosuppressive conditions or underlying HIV, malignancy, solids organ or stem cell transplants and were not on immunosuppressive medications.

Conclusions Our case and literature review demonstrate the possibility that PML may very rarely occur in patients that are immunocompetent. Furthermore, our review showed that patients responded well to mirtazapine and IVMP. In our case, the patient was treated with Pelfilgrastim with encouraging results and could be explored as a possible treatment option. We also want to highlight that mortality rate was lower in this review and was only compared to mortality in PML associated with immunocompromised status.

Authors/Disclosures
Syed Hassan Khalid, MD, MBBS (Loma Linda University, Department of Neurology) PRESENTER	Dr. Khalid has nothing to disclose.
Erum Khan (B.J.Medical College,Ahmedabad)	Ms. Khan has nothing to disclose.
Durgesh Chaudhary, MBBS (Penn State U, Milton S Hershey Medical Center)	Dr. Chaudhary has nothing to disclose.
Shitiz K. Sriwastava, MBBS (UT Health Houston)	Dr. Sriwastava has nothing to disclose.