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Atypical radiological presentation of progressive multifocal leukoencephalopathy following liver transplantation

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Abstract

Progressive multifocal leukoencephalopathy (PML), a demyelinating disease of the brain caused by JC virus (JCV), occurs following transplantation and other conditions associated with immunosupression. On magnetic resonance imaging (MRI), PML lesions typically appear as hyperintense signal on T2-weighted and FLAIR images located in the subcortical white matter, which are devoid of contrast enhancement or mass effect. The prognosis is poor, but unusual inflammatory forms of PML characterized by contrast enhancement have been associated with a cellular immune response against JCV and a better prognosis. The authors report an atypical presentation of PML with contrast-enhancing lesions and mass effect on the MRI in a liver transplant recipient, who had a progressive course and fatal outcome.

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Authors and Affiliations

  1. Neurology Department and Division of Viral Pathogenesis, Beth Israel Deaconess Medical Center, Harvard Medical School, Research East, Room 213B, 330 Brookline Avenue, 02215, Boston, MA, USA

    Marco A. Lima, Xin Dang & Igor J. Koralnik

  2. Division of Viral Pathogenesis, Harvard Medical School, Boston, Massachusetts, USA

    Marco A. Lima & Igor J. Koralnik

  3. Department of Surgery, Division of Transplantation and Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA

    Douglas W. Hanto

  4. Division of Gastroenterology, Harvard Medical School, Boston, Massachusetts, USA

    Michael P. Curry

  5. Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA

    Michael T. Wong

  6. School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

    Marco A. Lima

Authors
  1. Marco A. Lima
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  2. Douglas W. Hanto
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  3. Michael P. Curry
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  4. Michael T. Wong
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  5. Xin Dang
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  6. Igor J. Koralnik
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Corresponding author

Correspondence to Igor J. Koralnik.

Additional information

This work was supported by a Public Health Service grant R01 NS/AI 41198 and NS 047029. M.A. Lima is the recipient of a Fellowship from the National Scientific and Technological Development Council, CNPq-Brazil.

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Lima, M.A., Hanto, D.W., Curry, M.P. et al. Atypical radiological presentation of progressive multifocal leukoencephalopathy following liver transplantation. Journal of NeuroVirology 11, 46–50 (2005). https://doi.org/10.1080/13550280590900742

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  • DOI: https://doi.org/10.1080/13550280590900742

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