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Inflammatory infratentorial progressive multifocal leukoencephalopathy in a patient with rheumatoid arthritis |
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| Authors: | Boleslaw Lach Barbara Connolly Christian Wüthrich Igor J. Koralnik |
| Affiliation: | 1. Department of Pathology & Molecular Medicine, McMaster University, Hamilton Health Sciences, Hamilton General Hospital (Neuropathology), , Hamilton, Ontario, Canada;2. Department of Neurology, McMaster University, , Hamilton, Ontario, Canada;3. Division of Neuro‐Virology, Beth Israel Deaconess Medical Center, , Boston, Massachusetts, USA;4. Harvard Medical School, , Boston, Massachusetts, USA |
| Abstract: | An 84–year‐old man with rheumatoid arthritis (RA) treated with methotrexate, developed progressive confusion and cerebellar symptoms, and died approximately 2 months later. Neuropathological examination revealed progressive multifocal leukoencephalopathy (PML) involving the cerebellum and brainstem. The affected tissues displayed intense infiltrations by CD8+ T‐cells and microglia. JC virus was localized in oligodendroglia and cerebellar granule cells. This case illustrates unusual localization of inflammatory PML in a patient with RA treated with methotrexate. |
| Keywords: | cerebellar syndrome demyelination methotrexate progressive multifocal leukoencephalopathy rheumatoid arthritis |