A Case of Cerebellar-Onset Progressive Multifocal Leukoencephalopathy (PML) Associated with Hepatitis B-related Liver Cirrhosis

Kota Sato; Akiko Saito; Takeshi Miyazaki; Kazuo Nakamichi; Kenta Takahashi; Harutaka Katano; Tadaki Suzuki; Yuka Terasawa

doi:10.2169/internalmedicine.6263-25

A Case of Cerebellar-Onset Progressive Multifocal Leukoencephalopathy (PML) Associated with Hepatitis B-related Liver Cirrhosis

Intern Med. 2025 Nov 13. doi: 10.2169/internalmedicine.6263-25. Online ahead of print.

Authors

Kota Sato¹, Akiko Saito¹, Takeshi Miyazaki², Kazuo Nakamichi³, Kenta Takahashi⁴, Harutaka Katano⁴, Tadaki Suzuki⁴, Yuka Terasawa¹

Affiliations

¹ Department of Neurology, Brain Attack Center Ota Memorial Hospital, Japan.
² Department of Neurosurgery, Brain Attack Center Ota Memorial Hospital, Japan.
³ Department of Virology 1, National Institute of Infectious Diseases, Japan Institute for Health Security, Japan.
⁴ Department of Infectious Disease Pathology, National Institute of Infectious Diseases, Japan Institute for Health Security, Japan.

PMID: 41224270
DOI: 10.2169/internalmedicine.6263-25

Abstract

We herein report a case of progressive multifocal leukoencephalopathy (PML) in a woman in her 70s with hepatitis B-related liver cirrhosis. She presented with cerebellar onset symptoms, including ataxia and dysarthria. The diagnosis was delayed despite the initial magnetic resonance imaging (MRI) findings of an asymmetric cerebellar white matter lesion. PML was ultimately diagnosed based on a re-evaluation of a brain biopsy specimen and a retrospective JC virus (JCV) PCR analysis of the cerebrospinal fluid. Treatment with mefloquine and mirtazapine resulted in viral clearance from the cerebrospinal fluid (CSF) and clinical stabilization. This case highlights that crescent-shaped cerebellar lesions should raise suspicion of PML, even in patients without severe immunodeficiency.

Keywords: Crescent-shaped cerebellar lesion; Hepatitis B virus (HBV); JC virus (JCV); Liver cirrhosis; Progressive multifocal leukoencephalopathy (PML).