A case of immune reconstitution syndrome complicating progressive multifocal leukoencephalopathy after kidney transplant: Clinical, pathological, and radiographic features

Jackowiak, Eric; Shah, Nirav; Chen, Huiwen; Ojha, Ajitesh; Doyle, Joseph T.; Shepler, Anne M.; Bogdanovich, Tatiana; Silveira, Fernanda P.; Haidar, Ghady

doi:10.1111/tid.13162

Cited by 6 publications

(5 citation statements)

References 31 publications

(53 reference statements)

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“…The basal ganglia, corpus callosum, and posterior fossa can be involved. Contrast enhancement has been reported in PML-IRIS among SOTRs [83].…”

Section: Progressive Multifocal Leukoencephalopathymentioning

confidence: 87%

“…RIS is the mainstay for treatment. In kidney transplant recipients, complete elimination of immunosuppression may be considered as the SOTRs have the option of going back on dialysis [83]. Following favorable outcomes in a small group of nontransplant PML cases treated with Pembrolizumab [84], Medrano et al reported no improvement in outcomes in three SOTRs with PML who were treated the same regimen [85].…”

Section: Progressive Multifocal Leukoencephalopathymentioning

confidence: 99%

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Central nervous system infections after solid organ transplantation

Puthanveedu

Lum

2021

Current Opinion in Infectious Diseases

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Purpose of review Significant advances to our understanding of several neuroinfectious complications after a solid organ transplant (SOT) have occurred in the last few years. Here, we review the central nervous system (CNS) infections that are relevant to SOT via a syndromic approach with a particular emphasis on recent updates in the field. Recent findings A few key studies have advanced our understanding of the epidemiology and clinical characteristics of several CNS infections in SOT recipients. Risk factors for poor prognosis and protective effects of standard posttransplant prophylactic strategies have been better elucidated. Newer diagnostic modalities which have broad clinical applications like metagenomic next-generation sequencing, as well as those that help us better understand esoteric concepts of disease pathogenesis have been studied. Finally, several studies have provided newer insights into the treatment of these diseases. Summary Recent findings reflect the steady progress in our understanding of CNS infections post SOT. They provide several avenues for improvement in the prevention, early recognition, and therapeutic outcomes of these diseases.

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“…The basal ganglia, corpus callosum, and posterior fossa can be involved. Contrast enhancement has been reported in PML-IRIS among SOTRs [83].…”

Section: Progressive Multifocal Leukoencephalopathymentioning

confidence: 87%

Section: Progressive Multifocal Leukoencephalopathymentioning

confidence: 99%

Central nervous system infections after solid organ transplantation

Puthanveedu

Lum

2021

Current Opinion in Infectious Diseases

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“…In total, there have been 14 reported cases of PML post SOT or haematopoietic stem cell transplant (HSCT) in whom mirtazapine was used as adjunctive therapy and which are summarised in table 2 13 15–25. The reported time post-transplantation ranged from a few months to almost 20 years post-transplantation, with a mortality rate of 42.8% and reported survival of 10.7 months.…”

Section: Discussionmentioning

confidence: 99%

Progressive multifocal leukoencephalopathy 10 years following transplant: 5HT receptor antagonism as an adjunct to immune reconstitution

Chandler

Isbel

2022

BMJ Case Rep

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We report a case of a patient presenting with subacute neurological symptoms 10 years postkidney transplant. Cognitive deficits included acalculia and left upper limb dysesthesia, progressing to hemiplegic upper motor neuron weakness. Investigations included an MRI with multiple FLAIR hyperintensities, while a lumbar puncture was sterile with negative flow cytometry. Ultimately, PCR testing for John Cunningham virus was positive on cerebrospinal fluid. The diagnosis of progressive multifocal leukoencephalopathy (PML) was confirmed on the basis of the above.Initially, the patient was managed with withdrawal of immunosuppressants and close observation. Mirtazapine was commenced based on case reports of successful use in non-transplant patients; the patient’s recovery was temporally related to withdrawal of immunosuppression and increasing mirtazapine dosage. The patient is currently maintained on prednisolone and mirtazapine with stable graft function and improved mobility and cognitive function.

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“…Hematologic malignancies are the most common risk factors associated with PML [31]. The management consists of the reduction of immunosuppression and, in people living with HIV infection, initiation of antiretroviral therapy (ART) has an improvement in their outcome [1,32]. The Swiss cohort reported three cases with late presentation (range 15–28 months), tapering of immunosuppression was done, and one had acute rejection and graft loss and ultimately died [3 ▪▪ ].…”

Section: Viral Central Nervous System Infectionsmentioning

confidence: 99%

Solid organ transplant-related central nervous system infections

Morado-Aramburo,

Hasbun

2024

Current Opinion in Infectious Diseases

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Purpose of review Central nervous system (CNS) infections in solid organ transplant (SOT) recipients may present atypical or nonspecific symptoms. Due to a wider range of infectious agents compared with immunocompetent hosts, diagnosis is challenging. This review categorizes CNS infections in SOT recipients by cause. Recent findings New studies have reported new data on the epidemiology and the risk factors associated with each specific pathogen described in this review. Additionally, we included the treatment recommendations. Summary The latest findings give us an insight into the different pathogens causing infectious neurologic complications in SOT recipients.

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A case of immune reconstitution syndrome complicating progressive multifocal leukoencephalopathy after kidney transplant: Clinical, pathological, and radiographic features

Cited by 6 publications

References 31 publications

Central nervous system infections after solid organ transplantation

Central nervous system infections after solid organ transplantation

Progressive multifocal leukoencephalopathy 10 years following transplant: 5HT receptor antagonism as an adjunct to immune reconstitution

Solid organ transplant-related central nervous system infections

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