A Case Report of Progressive Multifocal Leukoencephalopathy in Peritoneal Dialysis

Abstract

We experienced a case manifesting progressive multifocal leucoencephalopathy (PML) in peritoneal dialysis (PD). A 27-year-old male patient had received a chronic PD therapy for 4 years. He had a past medical history of hypertension and myelodysplastic syndrome. He complained of hemiparesis with sudden onset and behavioral disorders. The patient seemed indifferent, incoherent with deficit walking. The cranial nerve examination showed a left central facial paralysis. Brain CT scan showed a paramedian right low density area not systemized, located in the corpus callosum and the centrum semiovale. Brain MRI confirmed the presence of PML by the detection of signal abnormalities in bilateral and asymmetrical white matter. The culture of cerebral spinal fluid was negative. The patient underwent six sessions of plasma exchange with favorable evolution. Few cases of PML have been reported in hemodialysis patients and no case has been previously described in PD. In our case, under immunocompromised conditions, precipitating factors appear multifactorial. Depressed immune system induced by chronic dialysis as well as liver disease and myelodysplasia might contribute to the development of florid clinical manifestation of PML.




World J Nephrol Urol. 2017;6(3-4):35-39
doi: https://doi.org/10.14740/wjnu316w