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Multiple central nervous system infections in progressive multifocal leukoencephalopathy

From the Departments of Pathology (Neuropathology) and Neurology, University of Pittsburgh School of Medicine and the Veterans Administration Hospital, Pittsburgh, Pennsylvania.

Clinical, pathologic, and immunologic features of two patients with progressive multifocal leukoencephalopathy and multiple coexisting central nervous system infections are presented. Both showed impaired cell-mediated immunity whereas immunoglobulins were normal, suggesting that defective cellular rather than humoral immunity predisposes to progressive multifocal leukoencephalopathy. Continued neurologic deterioration might be due not only to progression of the condition but also to simultaneous opportunistic bacterial and fungal infections that may be amenable to treatment. Unusual features in case 1 included striking neurologic remission for 8 months and a positive brain scan corresponding to a large demyelinated lesion in the frontal lobe.

This paper was presented in part at the twenty-sixth annual meeting of the American Academy of Neurology, San Francisco, April 1974.

Received for publication April 4, 1975.

Dr. Mathews' present address is Department of Neurology, General Hospital, Penang, Malaysia.

Reprint requests should be addressed to Dr. Moossy, Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261.

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