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JC Virus PCR Detection Is Not Infallible: A Fulminant Case of Progressive Multifocal Leukoencephalopathy with False-Negative Cerebrospinal Fluid Studies despite Progressive Clinical Course and Radiological Findings.

Babi MA, Pendlebury W, Braff S, Waheed W - Case Rep Neurol Med (2015)

Bottom Line: The patient passed away 3 months from the onset of her neurological symptoms.Autopsy confirmed the diagnosis of PML with presence of JC-polyoma virus by immunohistochemical staining.Additionally, appropriate exclusion of other neurologic conditions is essential.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurological Sciences, University of Vermont Medical Center, Burlington, VT 05401, USA.

ABSTRACT
We describe a case with a false-negative PCR-based analysis for JC virus in cerebrospinal fluid (CSF) in a patient with clinical and radiological findings suggestive of progressive multifocal leukoencephalopathy (PML) who was on chronic immunosuppressive therapy for rheumatoid arthritis. Our patient developed rapidly progressive global decline with clinical and radiographic findings suggestive of PML, but JC virus PCR in CSF was negative. The patient passed away 3 months from the onset of her neurological symptoms. Autopsy confirmed the diagnosis of PML with presence of JC-polyoma virus by immunohistochemical staining. This case highlights the potential of false-negative JC virus PCR in CSF when radiographic and clinical features are suggestive of "possible PML." We review the plausible causes of potential false-negative CSF results and suggest that when the clinical presentation is suspicious for PML repeat CSF analysis utilizing ultrasensitive PCR assay and subsequent brain biopsy should be considered if CSF remains negative. Additionally, appropriate exclusion of other neurologic conditions is essential.

No MeSH data available.


Related in: MedlinePlus

(a) PML gross pathology finding, right frontoparietal white matter lesion (black arrow). The subcortical whiter matter shows an irregular disruption measuring 1 × 1.5 cm. (b) Viral inclusions in an enlarged oligodendroglial nucleus (black arrow). (c) Bizarre reactive astrocyte with enlarged nucleus and prominent nucleolus. (d) Perivascular cuffing by lymphocytes. (e) Luxol Fast Blue/H&E stain showing an intranuclear inclusion (black arrow) and numerous foamy macrophages containing myelin debris (red arrow). (f) Immunocytochemistry using target-antibody against SV40, showing numerous positively stained oligodendroglia.
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fig2: (a) PML gross pathology finding, right frontoparietal white matter lesion (black arrow). The subcortical whiter matter shows an irregular disruption measuring 1 × 1.5 cm. (b) Viral inclusions in an enlarged oligodendroglial nucleus (black arrow). (c) Bizarre reactive astrocyte with enlarged nucleus and prominent nucleolus. (d) Perivascular cuffing by lymphocytes. (e) Luxol Fast Blue/H&E stain showing an intranuclear inclusion (black arrow) and numerous foamy macrophages containing myelin debris (red arrow). (f) Immunocytochemistry using target-antibody against SV40, showing numerous positively stained oligodendroglia.

Mentions: The patient continued to decline rapidly with confirmation on serial MRI (Figures 1(c) and 1(f)). She expired one day prior to a planned repeat lumbar puncture, approximately 3 months from the onset of her symptoms. Autopsy confirmed PML and the presence of JC virus by immunohistochemical staining (Figure 2).


JC Virus PCR Detection Is Not Infallible: A Fulminant Case of Progressive Multifocal Leukoencephalopathy with False-Negative Cerebrospinal Fluid Studies despite Progressive Clinical Course and Radiological Findings.

Babi MA, Pendlebury W, Braff S, Waheed W - Case Rep Neurol Med (2015)

(a) PML gross pathology finding, right frontoparietal white matter lesion (black arrow). The subcortical whiter matter shows an irregular disruption measuring 1 × 1.5 cm. (b) Viral inclusions in an enlarged oligodendroglial nucleus (black arrow). (c) Bizarre reactive astrocyte with enlarged nucleus and prominent nucleolus. (d) Perivascular cuffing by lymphocytes. (e) Luxol Fast Blue/H&E stain showing an intranuclear inclusion (black arrow) and numerous foamy macrophages containing myelin debris (red arrow). (f) Immunocytochemistry using target-antibody against SV40, showing numerous positively stained oligodendroglia.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4377394&req=5

fig2: (a) PML gross pathology finding, right frontoparietal white matter lesion (black arrow). The subcortical whiter matter shows an irregular disruption measuring 1 × 1.5 cm. (b) Viral inclusions in an enlarged oligodendroglial nucleus (black arrow). (c) Bizarre reactive astrocyte with enlarged nucleus and prominent nucleolus. (d) Perivascular cuffing by lymphocytes. (e) Luxol Fast Blue/H&E stain showing an intranuclear inclusion (black arrow) and numerous foamy macrophages containing myelin debris (red arrow). (f) Immunocytochemistry using target-antibody against SV40, showing numerous positively stained oligodendroglia.
Mentions: The patient continued to decline rapidly with confirmation on serial MRI (Figures 1(c) and 1(f)). She expired one day prior to a planned repeat lumbar puncture, approximately 3 months from the onset of her symptoms. Autopsy confirmed PML and the presence of JC virus by immunohistochemical staining (Figure 2).

Bottom Line: The patient passed away 3 months from the onset of her neurological symptoms.Autopsy confirmed the diagnosis of PML with presence of JC-polyoma virus by immunohistochemical staining.Additionally, appropriate exclusion of other neurologic conditions is essential.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurological Sciences, University of Vermont Medical Center, Burlington, VT 05401, USA.

ABSTRACT
We describe a case with a false-negative PCR-based analysis for JC virus in cerebrospinal fluid (CSF) in a patient with clinical and radiological findings suggestive of progressive multifocal leukoencephalopathy (PML) who was on chronic immunosuppressive therapy for rheumatoid arthritis. Our patient developed rapidly progressive global decline with clinical and radiographic findings suggestive of PML, but JC virus PCR in CSF was negative. The patient passed away 3 months from the onset of her neurological symptoms. Autopsy confirmed the diagnosis of PML with presence of JC-polyoma virus by immunohistochemical staining. This case highlights the potential of false-negative JC virus PCR in CSF when radiographic and clinical features are suggestive of "possible PML." We review the plausible causes of potential false-negative CSF results and suggest that when the clinical presentation is suspicious for PML repeat CSF analysis utilizing ultrasensitive PCR assay and subsequent brain biopsy should be considered if CSF remains negative. Additionally, appropriate exclusion of other neurologic conditions is essential.

No MeSH data available.


Related in: MedlinePlus