An autopsy case of progressive multifocal leukoencephalopathy with massive iron deposition in juxtacortical lesions

Progressive multifocal leukoencephalopathy (PML) is a severe demyelinating disease caused by JC virus infection of oligodendrocytes. Little has been reported on iron deposits in patients with PML. Herein, we report a case of PML with massive iron deposition in the juxtacortical regions attaching white matter lesions in a 71-year-old woman who developed bilateral visual disturbance and progressive aphasia after 16 months of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone treatment for follicular lymphoma. Magnetic resonance imaging revealed white matter lesions in the left parietal and other lobes with massive iron deposition in the juxtacortical lesions. A PCR test for JC virus was positive, confirming the diagnosis of PML. Despite treatment with mefloquine and mirtazapine, the patient died six months later. At autopsy, demyelination was found dominantly in the left parietal lobe. Moreover, hemosiderin-laden macrophages and reactive astrocytes containing ferritin were abundant in the juxtacortical regions adjacent to the white matter lesions. This is a previously unreported case of PML after lymphoma, in which iron deposition was confirmed both radiologically and pathologically.

Automated summary

This article reports a case of PML in a patient who developed bilateral visual disturbance and progressive aphasia after 16 months of treatment for follicular lymphoma. The MRI revealed white matter lesions with massive iron deposition. Autopsy findings confirmed the presence of abundant iron-laden macrophages and reactive astrocytes in the juxtacortical regions adjacent to the white matter lesions. This is the first reported case of PML after lymphoma with confirmed iron deposition.