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Fig. 2 | BMC Neurology

Fig. 2

From: Probable progressive multifocal leukoencephalopathy-immune reconstitution inflammatory syndrome with immunosuppressant dose reduction following lung transplantation: a case report and literature review

Fig. 2

Clinical course. Mycophenolate mofetil (500 mg) and tacrolimus (1.9 mg) were administered after the patient was released from the hospital. The patient’s excess apathy was noted 5 years after her lung transplant. This patient was admitted in our hospital 1 month after onset of apathy. Herpes encephalitis and acute disseminated encephalomyelitis were suspected at first. Accordingly, acyclovir and steroid pulse therapies were administered but were ineffective. Furthermore, JC polyoma virus (JCV)-PCR revealed transcript concentrations of 0.32 million copies/mL in the cerebrospinal fluid. Given these findings and those from magnetic resonance imaging (MRI), the patient was diagnosed with progressive multifocal leukoencephalopathy. Immunosuppressant drug levels were reduced, and an acute rejection episode was monitored via CD4-positive cell counts. Mefloquine treatment was also started. Although this patient’s CD4-positive cell counts gradually increased, her clinical symptoms progressed. She exhibited akinetic mutism 1 month after hospitalization (2 months after onset of PML). Despite increased CD4-positive cell counts, JCV-PCR copy numbers in the cerebrospinal fluid did not decrease, and her symptoms did not improve. Three months after her initial hospitalization (4 months after symptom onset), the patient died due to PML-related complications

*Brain MRI performed on admission; **Brain MRI performed 25 days after admission; ***Brain MRI performed 50 days after admission.

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