SIMULTANEOUS PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY, EPSTEIN-BARR-VIRUS (EBV) LATENT INFECTION AND CEREBRAL PARENCHYMAL INFILTRATION DURING CHRONIC LYMPHOCYTIC-LEUKEMIA

We report a non-HIV patient who had B chronic lymphocytic leukemia (CL L) with progressive multifocal leukoencephalopathy (PML) and diffuse c erebral leukemic parenchymal infiltration in the presence of JC virus and Epstein-Barr virus (EBV) cerebral co infection. Multiple subcortic al hypodensities lining the cortico-subcortical junction were present within the white matter on computerized tomography (CT) scan, with lar ge areas of high signal intensity on T2-weighted sequences on magnetic resonance imaging (MRI). JCV DNA was identified in peripheral blood n uclear cells and cerebrospinal fluid polymerase chain reaction (PCR) D NA/DNA hybridization plus Southern blot analysis. Frontal stereotactic biopsy confirmed the diagnosis of PML by immunocytochemistry, in situ hybridization (ISH) with JC Enzo probe and electron microscopy. Leuke mic B cells with the same phenotype as leukemic blood cells were disse minated in the demyelinated areas. They were labeled by anti-latent me mbrane protein and by BamHI W EBV probe after ISH. Adhesion and activa tion molecules were positive for CD23. Autopsy showed diffuse visceral leukemic infiltration without acutization. EBV-transformed B lymphocy tes would favour JCV penetration and/or intracerebral reactivation of previously latent JCV infection with further development of simultaneo us PML and cerebral CLL infiltration in an immuno-suppressed patient.