Brain, Progressive multifocal leukoencephalopathy [LMP62751]

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Diagnostic Modality: 
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Disease Category: 
Infectious Diseases
Diagnosis: 
Progressive multifocal leukoencephalopathy
Species: 
Human
Organ System: 
Central Nervous System
Gender: 
Female
Age: 
69 years
Diagnosis Code: 
ICD-10: A81.2
Slide Contributor Information
Gao, A., Munoz, D.

Keywords

PML, demyelination, demyelinating disease, JC virus

Clinical History

69-year-old woman with past medical history of chronic lymphocytic leukemia treated with chemotherapy. Presents with 2-week history of dysarthria, dysphagia, and ataxia. Neuroimaging shows multiple white matter lesions.

Clinical Discussion

Progressive multifocal leukoencephalopathy is a CNS demyelinating disorder caused by lytic infection of oligodendrocytes by JC (polyoma) virus. This is almost always due to reactivation of latent virus in an immunocompromised host. Microscopically, there is loss of myelin staining on Luxol Fast Blue along with myelin-laden macrophages and reactive, sometimes bizarre, astrocytes. Oligodendroglial viral inclusions, which can be highlighted with SV40 immunohistochemistry, are also seen. Prognosis is generally poor.

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Luxol Fast Blue stain
Immunohistochemistry SV40