{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T08:09:09Z","timestamp":1783152549042,"version":"3.54.6"},"reference-count":18,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,4,23]],"date-time":"2020-04-23T00:00:00Z","timestamp":1587600000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transplant Infectious Dis"],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating disease of the central nervous system caused by JC virus (JCV). The disease occurs in the setting of significant immunocompromise and has now been reported in many different settings, although only very rarely after lung transplantation. The mortality rate is high and therapeutic options are limited.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case presentation<\/jats:title><jats:p>We report a case of a 66\u2010year\u2010old man who presented with non\u2010specific memory disturbance at 19\u00a0months after lung transplantation for chronic hypersensitivity pneumonitis. He had required methylprednisolone for acute allograft rejection but achieved good graft function. Physical examination was unremarkable. CT revealed hypodensity in the left frontal lobe. MR demonstrated significant hyperintense white\u2010matter abnormalities on T2\u2010weighted and fluid\u2010attenuated inversion recovery (FLAIR) sequences, mainly focused on the periventricular region adjacent the frontal horn of the left lateral ventricle. Brain biopsy confirmed PML. The patient had his immunosuppression reduced but then developed antibody\u2010mediated rejection four\u00a0months later. Despite re\u2010escalation of immunosuppression, he remains neurologically stable on mirtazapine at eight months\u00a0post\u2010diagnosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This very rare case highlights the challenges presented by PML, especially in the lung transplant population. It reveals the difficult balance between reducing immunosuppression to protect the brain versus prevention of lung allograft rejection. It clearly highlights the need for improved therapeutic modalities.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tid.13293","type":"journal-article","created":{"date-parts":[[2020,4,15]],"date-time":"2020-04-15T06:46:06Z","timestamp":1586933166000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Progressive multifocal leukoencephalopathy in a lung transplant recipient presenting with memory impairment: Case report and literature review"],"prefix":"10.1111","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4873-5439","authenticated-orcid":false,"given":"Thomas","family":"Crowhurst","sequence":"first","affiliation":[{"name":"Discipline of Medicine University of Adelaide Adelaide SA Australia"},{"name":"SA Lung Transplant Service Royal Adelaide Hospital Central Adelaide Local Health Network Adelaide SA 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