Visual symptoms after lung transplantation: a case of progressive multifocal leukoencephalopathy.

Abstract

After solid organ transplantation, signs and symptoms of the central nervous system may present a diagnostic challenge. A 43-year-old patient developed a decrease in vision 15 months after bilateral lung transplantation. The initial diagnosis was a left posterior cataract, but left eye cataract extraction did not improve his vision. Seizures led to investigation of a broader differential diagnosis (cyclosporine intoxication, post-transplant lymphoproliferative disorder, infectious disease, chronic lymphatic leukemia). The clinical diagnosis of progressive multifocal leukoencephalopathy (PML) was confirmed by demonstration of JC virus in the cerebrospinal fluid and by autopsy findings. Modulation of the immunosuppressive regimen was unsuccessful. This case illustrates that decreased vision in immunocompromised patients may be the first manifestation of PML.

• Authors: J P Ouwens, H Haaxma-Reiche, E A Verschuuren, W Timens, L H Steenhuis, W J de Boer, W van der Bij, Groningen Lung Transplant Group
• Journal: Transplant infectious disease : an official journal of the Transplantation Society (Transpl Infect Dis) Vol. 2 Issue 1 Pg. 29-32 (Mar 2000) ISSN: 1398-2273 [Print] Denmark
• PMID: 11429007 (Publication Type: Case Reports, Journal Article)

Topics

• Adult
• Autopsy
• Brain (pathology)
• Cerebellum (pathology)
• Fatal Outcome
• Humans
• JC Virus (isolation & purification)
• Leukoencephalopathy, Progressive Multifocal (cerebrospinal fluid, diagnosis)
• Lung Transplantation
• Magnetic Resonance Imaging
• Male
• Postoperative Complications
• Vision Disorders (etiology)
• Visual Acuity