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progressive multifocal leukoencephalopathy—A Case Report in an Immunocompetent Patient

Advances in Infectious Diseases 2018年第1期8卷 10-16页

作者： Ana Faceira Daniela Magalhaes Filipa Ceia Joao Nuak Carina Reis Susana Ferreira Internal Medicine Department Hospital de Sao JoaoPortoPortugal Faculdade de Medicina da Universidade do Porto PortoPortugal Endocrinology Diabetes and Metabolism DepartmentHospital de Sao JoaoPortoPortugal Instituto de Investigacao e Inovacao em Saude Universidade do PortoPortoPortugal Infectious Diseases Department Hospital de Sao JoaoPortoPortugal Neuroradiology Department Hospital de Sao JoaoPortoPortugal

progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system due to the reactivation of the JC virus, which usually occurs in immunocompromised patients and is a major opportunistic infection associated with HIV infection. We report a case of a previously healthy patient who was diagnosed with PML.

关键词： Immunosuppression Immunocompetent JC Virus progressive multifocal leukoencephalopathy

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Pontocerebellar progressive multifocal leukoencephalopathy. Radiological, Clinical, Histological and Immunohistochemical Findings in a Hematological Patient

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Open Journal of Pathology 2023年第4期13卷 177-183页

作者： Javier Ortiz Juan Carlos Paniagua Isidro Cavaco Raquel Rivas Andrea Jimenez Luis Chinchilla Elisa Muñoz María Dolores Ludeña Departamento de Biología Celular y Patología Universidad de Salamanca (USAL) Salamanca Spain Servicio de Anatomía Patológica Hospital Universitario de Salamanca Salamanca Spain Servicio de Radiodiagnóstico Hospital Universitario de Salamanca Salamanca Spain

Objective: To describe the radiological, histological and immunohistochemical findings in a case of progressive multifocal leukoencephalopathy (PML) affecting the cerebellar peduncles in a patient with chronic lymphocytic leukemia. Patient and Methods: Magnetic Resonance Imaging (MRI), histological picture (H.E., Kluver-Barrera) and immunohistochemical picture (GFAP, neurofilaments, CD68, JC virus) were obtained. Results: 1) Magnetic resonance imaging: Asymmetric and progressive lesions on middle cerebellar peduncles, that were hyperintense in T2/FLAIR, extended towards the pons, had no mass effect and were unmodified after intravenous contrast. 2) Histology: Marked reactive gliosis with cytopathic changes suggesting viral infection, plus demyelination areas with axonal preservation. 3) Immunohistochemistry: Marked positivity for viral (polyoma and JC virus) markers in glial cells showing cytopathic changes. Conclusions: The importance of histological and immunohistochemical diagnosis in everyday assistance;of the collaboration between clinicians, radiologists and pathologists;and the validity of postmortem studies as a key element for research and clinical quality assessment must be stressed.

关键词： progressive multifocal leukoencephalopathy JC Virus Immunohistochemistry

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Effects of Comprehensive Rehabilitation on Patients with progressive multifocal leukoencephalopathy Due to Systemic Lupus Erythematosus: A Case Report

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Journal of Behavioral and Brain Science 2023年第8期13卷 143-156页

作者： Xiaoli Wu Xueyan Hu Yuge Zhang Lixu Liu Department of Neurorehabilitation Rehabilitation Medicine of Capital Medical University China Rehabilitation Research Centre Beijing China

Introduction: Little is known about the feasibility and effectiveness of rehabilitative treatment for systemic lupus erythematosus (SLE) in individuals with progressive multifocal leukoencephalopathy (PML). We describe a patient with SLE complicated by PML and ameliorated by comprehensive rehabilitation. We also review the epidemiology, pathology, imaging characteristics, and treatment of PML. Patient Concerns: We found a patient with SLE with PML improved by multidisciplinary rehabilitation techniques. Diagnoses, Interventions, and Outcomes: We diagnosed a PML with a 13-year history of SLE and lupus nephritis after longtime immunosuppressive therapy. The patient underwent a comprehensive, multifaceted rehabilitation program, including drug therapy, integrated physical therapy, occupational therapy, acupuncture, music therapy, computer-aided cognitive rehabilitation training, and behavioral management training. This rehabilitation program improved her motor function and activities of daily living. Conclusions: Her condition improved in the short term through comprehensive rehabilitation, including physical, speech, and cognitive therapy. Therefore, we recommend comprehensive rehabilitation to improve the function and activities of daily living in patients with PML.

关键词： progressive multifocal leukoencephalopathy Systemic Lupus Erythematosus Rehabilitation Prognosis Case Report

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Neurological complications of hematopoietic cell transplantation in children and adults

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Neural Regeneration Research 2018年第6期13卷 945-954页

作者： Adriana Octaviana Dulamea Ioana Gabriela Lupescu University of Medicine and Pharmacy Carol Davila Bucharest Romania Department of Neurology Fundeni Clinical Institute Bucharest Romania Radiology and Medical imaging Department Fundeni Clinical Institute Bucharest Romania

Hematopoietic cell transplantation（HCT） is widely performed for neoplastic and non-neoplastic diseases. HCT involves intravenous infusion of hematopoietic progenitor cells from human leukocyte antigen（HLA）-matched donor（allogeneic） or from the patient（autologous）. Before HCT, the patient is prepared with high dose chemotherapy and/or radiotherapy to destroy residual malignant cells and to reduce immunologic resistance. After HCT, chemotherapy is used to prevent graft rejection and graft versus host disease（Gv HD）. Neurological complications are related to the type of HCT, underlying disease, toxicity of the conditioning regimens, immunosuppression caused by conditioning regimens, vascular complications generated by thrombocytopenia and/or coagulopathy, Gv HD and inappropriate immune response. In this review, neurological complications are presented according to time of onset after HCT：（1） early complications（in the first month）-related to harvesting of stem cells, during conditioning（drug toxicity, posterior reversible encephalopathy syndrome）, related to pancytopenia,（2） intermediate phase complications（second to sixth month）-central nervous system infections caused by prolonged neutropenia and progressive multifocal leukoencephalopathy due to JC virus,（3） late phase complications（after sixth month）-neurological complications of Gv HD, second neoplasms and relapses of the original disease.

关键词： neurological complications hematopoietic cell transplantation posterior reversible encephalopathy syndrome central nervous system infections progressive multifocal leukoencephalopathy graft versus host disease second neoplasm immune reconstitution inflammatory syndrome post-transplant acute limbic encephalitis drug reaction with eosinophiIia and systemic symptoms

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