Successful treatment of progressive multifocal leukoencephalopathy that developed 21 years after renal transplantation: A case report

Progressive multifocal leukoencephalopathy (PML) is a fatal central nervous system demyelinating disease that affects immunocompromised patients. Although rare, transplant recipients can develop PML. We report the case of a 60-year-old woman who developed PML 21 years after renal transplantation. Although the clinical course and findings mimicked brain tumor, PML was diagnosed by identification of JCV DNA in CSF and brain pathological findings. Mefloquine and mirtazapine were administered, and immunosuppressants were discontinued. Thereafter, neurological symptoms and radiological findings stabilized. PML can develop in transplant recipients a long time after transplantation. In posttransplantation PML, discontinuation of immunosuppressants may contribute to better outcomes. Therefore, the possibility of immunosuppressant discontinuation should be carefully evaluated.