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A case of immune reconstitution syndrome complicating progressive multifocal leukoencephalopathy after kidney transplant: Clinical, pathological, and radiographic features
Author(s) -
Jackowiak Eric,
Shah Nirav,
Chen Huiwen,
Ojha Ajitesh,
Doyle John,
Shepler Anne,
Bogdanovich Tatiana,
Silveira Fernanda P.,
Haidar Ghady
Publication year - 2019
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.13162
Subject(s) - medicine , progressive multifocal leukoencephalopathy , immune reconstitution inflammatory syndrome , immunosuppression , opportunistic infection , immune system , brain biopsy , pathology , complication , kidney , biopsy , immunology , human immunodeficiency virus (hiv) , virus , viral disease , antiretroviral therapy , viral load
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.