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PML — SCE Infectious Diseases MCQ

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HardImmunocompromised HostPMLSCE Infectious Diseases

A 40-year-old woman with systemic lupus erythematosus on Rituximab and Prednisolone presents with 2 weeks of progressive headache and visual disturbance. MRI brain shows multiple ring-enhancing lesions in the white matter with restricted diffusion. CSF JC virus PCR is positive. What is the most likely diagnosis?

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Correct answer: A — Progressive multifocal leukoencephalopathy

Progressive multifocal leukoencephalopathy (PML) is caused by JC virus reactivation in immunocompromised patients. Rituximab-associated PML is a recognised complication. MRI typically shows multifocal white matter lesions without mass effect (though atypical ring-enhancing forms occur with immune reconstitution). CSF JC virus PCR confirmation is diagnostic. There is no specific antiviral treatment; management focuses on immune reconstitution by withdrawing immunosuppression. CNS lymphoma and Toxoplasma are differential diagnoses but JC virus positivity is diagnostic.

Reference: BHIVA 2022 – OI guidelines; NICE CKS 2024 – PML