Brain Biopsy Is More Reliable than the DNA test for JC Virus in Cerebrospinal Fluid for the Diagnosis of Progressive Multifocal Leukoencephalopathy

Junji Ikeda; Akira Matsushima; Wataru Ishii; Tetuya Goto; Kenta Takahashi; Kazuo Nakamichi; Masayuki Saijo; Yoshiki Sekijima; Shu-ichi Ikeda

doi:10.2169/internalmedicine.56.7689

CASE REPORTS

Brain Biopsy Is More Reliable than the DNA test for JC Virus in Cerebrospinal Fluid for the Diagnosis of Progressive Multifocal Leukoencephalopathy

Junji Ikeda, Akira Matsushima, Wataru Ishii, Tetuya Goto, Kenta Takahashi, Kazuo Nakamichi, Masayuki Saijo, Yoshiki Sekijima, Shu-ichi Ikeda

Author information

Junji Ikeda
Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan
Akira Matsushima
Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan
Wataru Ishii
Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan
Tetuya Goto
Department of Neurosurgery, Shinshu University School of Medicine, Japan
Kenta Takahashi
Department of Pathology, National Institute of Infectious Diseases, Japan
Kazuo Nakamichi
Division of Virology 1, National Institute of Infectious Diseases, Japan
Masayuki Saijo
Division of Virology 1, National Institute of Infectious Diseases, Japan
Yoshiki Sekijima
Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan
Shu-ichi Ikeda
Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Japan

Keywords: progressive multifocal leukoencephalopathy, JC virus, DNA test, brain biopsy, demyelination, slow virus infection

JOURNAL OPEN ACCESS

2017 Volume 56 Issue 10 Pages 1231-1234

DOI https://doi.org/10.2169/internalmedicine.56.7689

Details

Abstract

The current standard diagnostic approach for progressive multifocal leukoencephalopathy (PML) is to perform a DNA test to identify the presence of the JC virus in cerebrospinal fluid (CSF). A 32-year-old woman with a 5-year history of systemic lupus erythematosus developed right hemiplegia and motor aphasia. MRI revealed a large white matter lesion in the left frontal lobe. JC virus DNA was undetectable in the CSF, but a brain biopsy showed typical histopathology and a high DNA load of the JC virus. The patient was treated with mefloquine and mirtazapine, and is currently alive at 24 months after onset. An early brain biopsy may therefore be important for making a timely diagnosis of PML.

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