Progressive multifocal leukoencephalopathy in patients with chronic kidney disease

Progressive multifocal leukoencephalopathy (PML) is an opportunistic central nervous system infection caused by the human polyomavirus 2, leading to demyelination from oligodendrocyte death and rapid neurologic decline. Most commonly, PML affects patients in immunocompromised states. However, rare reports of PML in an immunocompetent host exist. Here, we report two cases of PML in older individuals with chronic kidney disease (CKD). CKD can ultimately lead to immune system dysfunction and place patients in a relatively immunosuppressed state. Testing for JC virus should remain a consideration for rapid, unexplained neurologic decline even without known immunocompromised status in the appropriate clinical setting.

Automated summary

Progressive multifocal leukoencephalopathy (PML) is a central nervous system infection caused by human polyomavirus 2, usually affecting immunocompromised patients. However, this report presents two cases of PML in older individuals with chronic kidney disease (CKD). CKD can lead to immune system dysfunction and potentially increase the risk of PML.