PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY DURING CYCLOSPORINE TREATMENT - A CASE-REPORT

A 45-year-old patient suffering from chronic renal insufficiency, deve loped dermatopolymyositis. Since the patient did not respond to treatm ent with high doses of prednisone and immunoglobulin, concomitant cycl osporine A was added. Four months Inter, worsening signs of bilateral pyramidal disorder and an altered state of consciousness appeared Seri al computed tomography (CT) and magnetic resonance imaging (MRI) revea led multiple alterations of the cerebral white matter Cyclosporine was then discontinued One month later exitus occurred Microscopic examina tion of the brain showed diffuse tumescence; histological examination revealed perivascular and diffuse lymphomonocyte infiltrations, areas of demyelination, astrocytes with bizarre nuclei, and oligodendrocytes with enlarged nuclei due to hyperchromatic inclusion. Morphological e xamination confirmed the presence of intranuclear icosahedral viral bo dies. Progressive multifocal leukoencephalopathy was diagnosed. The li terature contains only one report of an analogous case observed during a course of cyclosporine treatment for Wegener's granulomatosis.