Progressive multifocal leukoencephalopathy after a kidney transplantation: based on literature review and own clinical case

Prof. T.A. Litovchenko, O. V. Vostrotin, As.prof. O.L. Tondiy, ass. V. V. Lebedynets, Y. L. Kolinko

Kharkiv Medical Academy of Postgraduate Education, Department of Neurology and Pediatric Neurology

This article discusses the development of progressive multifocal leukoencephalopathy after a kidney transplantation on the background of immunosuppressive therap. It’s the example of a clinical case. Based on the literature review, it is known that progressive multifocal leukoencephalopathy is a progressive demyelinating disease of the central nervous system, which is caused by reactivation of the latent JC virus; such reactivation usually occurs in immunodeficient conditions. In the clinical case, the appearance of this disease was demonstrated and its severe and potentially fatal multifocal lesion of the white matter of the brain was proved. The disease was developed on the background of immunosuppressive therapy after a history of kidney transplantation. The understanding of the clinical course of progressive multifocal leukoencephalopathy, the absence of specific neurological manifestations and course were expanded. It is noted that MRI results in addition to the clinical picture and anamnestic data help to establish the diagnosis of PML and make a differential diagnosis. Progressive multifocal leukoencephalopathy in transplant recipients receiving immunosuppressive therapy have an unfavorable prognosis.

Key Words: progressive multifocal leukoencephalopathy, demyelination, oligodendrocyte, polyomavirus, multiple sclerosis, acute disseminated postinfectious encephalomyelitis.

https://dx.doi.org/10.15407/internalmed2021.02b.113

Download.PDF (ukr)

Cite:

  1. Литовченко, Т.А. Прогресуюча мультифокальна лейкоенцефалопатія після трансплантації нирки: літературний огляд і власний клінічний випадок / Т.А Литовченко, О.В. Востротін, О.Л. Тондій, В.В. Лебединець, Ю.Л. Колинько // Східноєвропейський журнал внутрішньої та сімейної медицини. – 2021. – № 2(Б). – С. 113-116. doi: 10.15407/internalmed2021.02b.113
  2. Litovchenko TA, Vostrotin OV, Tondiy OL, Lebedynets VV, Kolinko YuL. Proghresujucha muljtyfokaljna lejkoencefalopatija pislja transplantaciji nyrky: literaturnyj oghljad i vlasnyj klinichnyj vypadok. [Progressive multifocal leukoencephalopathy after a kidney transplantation: based on literature review and own clinical case]. Shidnoevr. z. vnutr. simejnoi med. 2021;2b:113-116. Ukrainian. doi: 10.15407/internalmed2021.02b.113

References

  1. Zaharova, MN. Progressirujushhaja mul’tifokal’naja lejkojencefalopatija kak oslozhnenie lechenija preparatami, izmenjajushhimi techenie rassejannogo skleroza. Annaly klinicheskoj i jeksperimental’noj nevrologii 12.4 (2018). Russian
  2. Shimbo E, Nukuzuma S, Tagawa Y. Human iPS cell–derived astrocytes support efficient replication of progressive multifocal leukoencephalopathy-type JC polyomavirus. Biochemical and Biophysical Research Communications. 2020;533(4):983-987. http://dx.doi.org/10.1016/j.bbrc.2020.09.117
  3. Panteleienko, LV, Mialovytsk OA, Lobanov OV. “Prohresyvna multyfokalna leikoentsefalopatiia u khvorykh na syndrom nabutoho imunodefitsytu (ohliad literatury ta vlasne klinichne sposterezhennia).” Ukrainskyi nevrolohichnyi zhurnal.2017;(1): 72-76. Ukraininan
  4. Major E, Yousry T, Clifford D. Pathogenesis of progressive multifocal leukoencephalopathy and risks associated with treatments for multiple sclerosis: a decade of lessons learned. The Lancet Neurology. 2018;17(5):467-480. http://dx.doi.org/10.1016/s1474-4422(18)30040-1
  5. Maltsev DV. Prohresuiucha multyfokalna leikoentsefalopatiia, asotsiiovana z virusom herpesu liudyny 6-ho typu. Ukrainskyi medychnyi chasopys. 2012;1: 136-142. Ukraininan
  6. Wortman M, Lundberg P, Dagdanova A, Venkataraman P, Daniel D, Johnson E. Opportunistic DNA Recombination With Epstein-Barr Virus at Sites of Control Region Rearrangements Mediating JC Virus Neurovirulence. Journal of Infectious Diseases. 2015;213(9):1436-1443. http://dx.doi.org/10.1093/infdis/jiv755
  7. Allen U, Preiksaitis J. Post‐transplant lymphoproliferative disorders, Epstein‐Barr virus infection, and disease in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clinical Transplantation. 2019;33(9):. http://dx.doi.org/10.1111/ctr.13652
  8. Breville G, Koralnik I, Lalive P. Brainstem progressive multifocal leukoencephalopathy. European Journal of Neurology. 2020;28(3):1016-1021. http://dx.doi.org/10.1111/ene.14617
  9. Bag A, Curé J, Chapman P, Roberson G, Shah R. JC Virus Infection of the Brain. American Journal of Neuroradiology. 2010;31(9):1564-1576. http://dx.doi.org/10.3174/ajnr.a2035
  10. Richardson E. Progressive Multifocal Leukoencephalopathy. New England Journal of Medicine. 1961;265(17):815-823. http://dx.doi.org/10.1056/nejm196110262651701
  11. Poiasnyk IM. Prohresuiucha multyfokalna leikoentsefalopatiia u khvoroi z ko-infektsiieiu-VIL ta tuberkulozom. Precarpathian Bullettin of the Shevchenko Scientific Society Pulse. 2017; 7(43): 30-35. Ukraininan