John Cunningham virus

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  • CNS infection with JC virus, usually in the context of HIV infection

Background

Epidemiology

  • HIV patients

Clinical Presentation

  • Classic PML
    • Subacute onset of focal central neurological lesions
    • Asymmetric, well-demarcated, nonenchancing subcortical white matter lesions on MRI
  • PML-IRIS
    • Focal central neurological lesions following immune recovery
    • Contrast enhancing lesions with or without mass effect on MRI
  • JCV granule cell neuropathy
    • Chronic cerebellar dysfunction
    • Cerebellar atrophy on MRI
  • JCV encephalitis
    • Subacute onset of encephalopathy
    • Cortical lesions on MRI
  • JCV meningitis
    • Chronic headaches
    • Ventriculomegaly on MRI

Investigations

  • MRI head: white matter changes
  • CSF: fairly nonspecific, with mild pleocytosis, slightly elevated protein, and normal glucose
    • PCR of CSF has sensitivity 58% with ART or 72-92% without, and specificity 92-100%

Diagnosis

  • JC virus PCR of CSF or brain biopsy

Treatment

  • Antiretroviral therapy for HIV