A case of immune reconstitution syndrome complicating progressive multifocal leukoencephalopathy after kidney transplant: Clinical, pathological, and radiographic features
| Autor: | John Doyle, Tatiana Bogdanovich, Eric Jackowiak, Huiwen Chen, Fernanda P. Silveira, Ajitesh Ojha, Nirav Shah, Ghady Haidar, Anne M. Shepler |
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| Rok vydání: | 2019 |
| Předmět: |
Transplantation
Pathology medicine.medical_specialty medicine.diagnostic_test business.industry Brain biopsy Progressive multifocal leukoencephalopathy medicine.medical_treatment JC virus Immunosuppression 030230 surgery medicine.disease_cause medicine.disease Lymphoma 03 medical and health sciences 0302 clinical medicine Infectious Diseases Immune system Immune reconstitution inflammatory syndrome medicine 030211 gastroenterology & hepatology Complication business |
| Zdroj: | Transplant Infectious Disease. 21 |
| ISSN: | 1399-3062 1398-2273 |
| DOI: | 10.1111/tid.13162 |
| Popis: | Progressive multifocal leukoencephalopathy (PML) is a life-threatening central nervous system (CNS) disorder, most commonly described in patients infected with the human immunodeficiency virus (HIV). Limited data exist on its natural history and treatment in solid organ transplant (SOT) recipients. A complication of PML is the immune reconstitution inflammatory syndrome (IRIS), which develops after T cell reconstitution and can have severe consequences when it occurs in the CNS. While well described in HIV-infected individuals, its clinical features, diagnosis, and treatment after SOT are largely unknown. We report a case of a kidney transplant recipient who was diagnosed with PML and developed significant worsening of her symptoms upon reduction of immunosuppression. Thallium SPECT showed avid uptake suggestive of lymphoma, but the diagnosis of PML-IRIS was ultimately established by brain biopsy. She survived with nearly complete restoration of her functional status after a prolonged steroid taper. |
| Databáze: | OpenAIRE |
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