ENCEPHALOPATHY-PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY (PML)

SUMMARY

1. It is typically seen in patients with T-cell immune defects (HIV/AIDS, chronic steroids, monoclonal antibodies), chronic neoplastic diseases.

2. Also assoc. with immunosuppressants for treatment of rheumatologic, hematologic, and IBD (rituximab, fludarabine, mycophenolate, chronic corticosteroids)

3. PML is caused by the human JC polyomavirus, resulting in a progressive demyelination of the CNS white matter.

4. Symptoms - personality changes and intellectual impairment, slurred speech.

5. Initial symptoms followed by hemiparesis progressing to quadriparesis, visual field defects, cortical blindness, aphasia, ataxia, dysarthria, dementia, confusional states, and/or coma. Some have predominantly cerebellar syndrome.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].