Progressive multifocal leukoencephalopathy


  • Progressive multifocal leukoencephalopathy (PML) is a rare, demyelinating CNS disorder
  • Associated with reactivated JC virus
  • Seen almost exclusively in immunosuppressed patients, usually due to:

Clinical Features

Differential Diagnosis

Altered mental status

Diffuse brain dysfunction

Primary CNS disease or trauma



  • Evaluate for other (especially easily treatable) causes of symptoms
  • MRI brain: non-enhancing, multifocal areas of white matter demyelination
  • PCR for JC virus (CSF, blood, urine)


  • Limit duration of immunosuppression
    • HIV/AIDS patients, antiretroviral therapy is key
  • Cidofovir may be useful in non-AIDS patients


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