{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:06:53Z","timestamp":1756339613960,"version":"3.44.0"},"reference-count":23,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,3,9]]},"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:p>A 59-year-old man, with a background of multiply relapsed myeloma, presented with a 3-week history of confusion, short-term memory impairment and behavioural changes. CT head showed bilateral white matter changes and numerous, large lytic lesions of the skull vault. MRI brain revealed multiple areas of hyperintensity on T2-weighted sequences which did not enhance (many of which showed diffusion restriction) unexpectedly bringing progressive multifocal leukoencephalopathy (PML) into the differential. Initial cerebrospinal fluid studies were largely unremarkable, aside from a mildly elevated protein; cultures were negative. PCR for the John Cunningham (JC) virus was positive. Considering the patient\u2019s medical history and rapidily progressive symptoms, a palliative approach was adopted, with the patient dying 14 days later. We present this case as an example of PML in a patient with multiple myeloma, highlighting the need to consider this diagnosis in an enlarging population of heavily treated, severely immunocompromised, patients.<\/jats:p>","DOI":"10.1136\/bcr-2019-233552","type":"journal-article","created":{"date-parts":[[2020,3,23]],"date-time":"2020-03-23T06:35:13Z","timestamp":1584945313000},"page":"e233552","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Progressive multifocal leukoencephalopathy following five lines of therapy and three autologous bone marrow transplants for multiple myeloma"],"prefix":"10.1136","volume":"13","author":[{"given":"Kathryn","family":"Knight","sequence":"first","affiliation":[{"name":"Core Medical Trainee, NHS Fife, Kirkaldy, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siobhan","family":"Chien","sequence":"additional","affiliation":[{"name":"Foundation Year Doctor, NHS Fife, Kirkaldy, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ioannis","family":"Koutsavlis","sequence":"additional","affiliation":[{"name":"Haematology, NHS Fife, Kirkaldy, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victoria","family":"Campbell","sequence":"additional","affiliation":[{"name":"Haematology, NHS Fife, Kirkaldy, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,3,22]]},"reference":[{"key":"2025082713211013000_13.3.e233552.1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(18)30040-1"},{"key":"2025082713211013000_13.3.e233552.2","doi-asserted-by":"crossref","DOI":"10.1186\/1752-1947-6-177","article-title":"Smoldering myeloma presenting as progressive multifocal leukoencephalopathy: a case report","volume":"6","author":"Troppmann","year":"2012","journal-title":"J Med Case Rep"},{"key":"2025082713211013000_13.3.e233552.3","doi-asserted-by":"crossref","first-page":"2004","DOI":"10.1007\/s00415-016-8217-x","article-title":"Drug-Associated progressive multifocal leukoencephalopathy: a clinical, radiological, and cerebrospinal fluid analysis of 326 cases","volume":"263","author":"Maas","year":"2016","journal-title":"J Neurol"},{"key":"2025082713211013000_13.3.e233552.4","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2010.164"},{"key":"2025082713211013000_13.3.e233552.5","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2017008201"},{"key":"2025082713211013000_13.3.e233552.6","doi-asserted-by":"crossref","DOI":"10.3389\/fimmu.2015.00159","article-title":"Immune system involvement in the pathogenesis of JC virus induced PML: what is learned from studies of patients with underlying diseases and therapies as risk factors","volume":"6","author":"Monaco","year":"2015","journal-title":"Front Immunol"},{"key":"2025082713211013000_13.3.e233552.7","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1007\/s12185-010-0600-2","article-title":"Progressive multifocal leukoencephalopathy in a patient with multiple myeloma","volume":"92","author":"Akiyama","year":"2010","journal-title":"Int J Hematol"},{"key":"2025082713211013000_13.3.e233552.8","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1038\/nrrheum.2014.167","article-title":"Sorting out the risks in progressive multifocal leukoencephalopathy","volume":"11","author":"Calabrese","year":"2015","journal-title":"Nat Rev Rheumatol"},{"key":"2025082713211013000_13.3.e233552.9","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1080\/14740338.2016.1198775","article-title":"Detection of cases of progressive multifocal leukoencephalopathy associated with new biologicals and targeted cancer therapies from the FDA's adverse event reporting system","volume":"15","author":"Raisch","year":"2016","journal-title":"Expert Opin Drug Saf"},{"key":"2025082713211013000_13.3.e233552.10","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e31828c2fa1"},{"key":"2025082713211013000_13.3.e233552.11","doi-asserted-by":"crossref","first-page":"1668","DOI":"10.1038\/bmt.2010.33","article-title":"Atypical presentation of progressive multifocal leukoencephalopathy in a multiple myeloma patient after auto-SCT successfully treated with combination therapy","volume":"45","author":"Fianchi","year":"2010","journal-title":"Bone Marrow Transplant"},{"key":"2025082713211013000_13.3.e233552.12","doi-asserted-by":"crossref","first-page":"S153","DOI":"10.1016\/j.bbmt.2015.11.505","article-title":"Progressive Multifocal Leukoencephalopathy Associated with Hematopoietic Stem Cell Transplant (HSCT) Has Better Prognosis Than PML Associated with Monoclonal Antibodies or Chemotherapy in Hematological Malignancies : Analysis of a Case Series","volume":"22","author":"Raajasekar","year":"2016","journal-title":"Biol Blood Marrow Transplant"},{"key":"2025082713211013000_13.3.e233552.13","unstructured":"Naismith RT . 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