Progressive Multifocal Leukoencephalopathy With Peripheral Demyelinating Neuropathy in a Liver Transplant Patient

Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating disorder of the central nervous system, which is caused by the JC virus. Even though PML has been documented in organ transplant recipients, peripheral demyelinating neuropathy associated with PML has not been reported in solid organ transplant recipients. We present a case of PML associated with both central and peripheral nervous system involvement in a liver transplant patient. Seven weeks after orthotopic liver transplant, a 45-year-old woman developed myalgias, decreased vision, and paresthesia in the fourth and fifth fingers of both hands as well as a right foot drop. Neuroradiologic imaging of the brain showed a nonspecific low attenuation lesion in the right frontal lobe of the brain consistent with PML, which was later confirmed by a JC virus, DNA-specific polymerase chain reaction (PCR) of the cerebrospinal fluid (CSF) and characteristic autopsy findings of the brain, including in-situ hybridization (ISH) of brain tissue.