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July 1976

Progressive Multifocal Leukoencephalopathy in Renal Transplant Recipients

Arch Intern Med. 1976;136(7):829-834. doi:10.1001/archinte.1976.03630070067020

Progressive multifocal leukoencephalopathy (PML), a slowly progressive papovavirus infection of the central nervous system (CNS), has been reported in more than 110 patients to date, over half of whom have had either leukemia or lymphoma.1-13 Only occasionally has no obvious underlying immune-altering disorder been noted.1,2 To our knowledge, only three patients have been reported previously to have developed PML after long-term immunosuppression for renal transplantation5,12,13; the patient discussed here is the fourth. Our patient also demonstrated unilateral parkinsonian signs attributable to involvement of the extrapyramidal motor system. Parkinsonism has been a very unusual clinical manifestation of PML, and has been reported previously in only one patient.14 We believe that PML is emerging as a potentially serious problem in renal transplant recipients.

PATIENT SUMMARY  A 34-year-old man who had had multiple admissions for chronic renal failure and hypertension caused by chronic proliferative glomerulonephritis had both kidneys (and