{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T00:19:28Z","timestamp":1760746768374,"version":"build-2065373602"},"reference-count":12,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,9,30]]},"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:p>Progressive multifocal leukoencephalopathy (PML) is a rare central nervous system disease caused by John Cunningham (J.C.) virus reactivation in the setting of immunosuppression. We describe a young woman with chronic migraines, Factor V Leiden and prior intravenous drug use who presented with headache, fatigue and bilateral leg weakness. Imaging demonstrated stable subcortical T2\/fluid-attenuated inversion recovery hyperintensities consistent with prior PML. During evaluation, she was found to have an autoimmune hepatitis flare associated with transient worsening of her neurologic deficits, suggesting PML recrudescence. This case highlights the potential for autoimmune-mediated perturbations in unmasking latent J.C. virus activity and underscores the importance of multidisciplinary care and ongoing research in managing atypical PML presentations.<\/jats:p>","DOI":"10.1136\/bcr-2024-263621","type":"journal-article","created":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T11:15:20Z","timestamp":1760699720000},"page":"e263621","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Progressive multifocal leukoencephalopathy recrudescence in an autoimmune hepatitis flare"],"prefix":"10.1136","volume":"18","author":[{"given":"Jonathan Daniel","family":"Evers","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Cleveland Clinic Akron General, Akron, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachida","family":"Bouhenni","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Cleveland Clinic Akron General, Akron, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shivnaveen","family":"Bains","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Cleveland Clinic Akron General, Akron, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramnath Santosh","family":"Ramanathan","sequence":"additional","affiliation":[{"name":"Department of Neurology, Aultman Hospital, Canton, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,10,17]]},"reference":[{"key":"2025101704150976000_18.10.e263621.1","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1093\/brain\/awab419","article-title":"The neuroradiology of progressive multifocal leukoencephalopathy: a clinical trial perspective","volume":"145","author":"Baldassari","year":"2022","journal-title":"Brain (Bacau)"},{"key":"2025101704150976000_18.10.e263621.2","doi-asserted-by":"publisher","DOI":"10.1007\/s13365-013-0222-6"},{"key":"2025101704150976000_18.10.e263621.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200108093450606"},{"key":"2025101704150976000_18.10.e263621.4","first-page":"412","article-title":"A rare case of progressive multifocal leukoencephalopathy in systemic lupus erythematosus on azathioprine","volume":"29","author":"Smith","year":"2023","journal-title":"J Neurovirol"},{"key":"2025101704150976000_18.10.e263621.5","first-page":"98","article-title":"PML unmasked by teclistamab therapy in relapsed\/refractory multiple myeloma","volume":"12","author":"Gupta","year":"2023","journal-title":"Infectious Diseases in Oncology"},{"key":"2025101704150976000_18.10.e263621.6","doi-asserted-by":"crossref","DOI":"10.1186\/s12987-020-00227-y","article-title":"Cerebrospinal fluid analysis in 108 patients with progressive multifocal leukoencephalopathy","volume":"17","author":"M\u00f6hn","year":"2020","journal-title":"Fluids Barriers CNS"},{"key":"2025101704150976000_18.10.e263621.7","first-page":"45","article-title":"First report of progressive multifocal leukoencephalopathy in childhood-onset NMOSD","volume":"104","author":"Rodr\u00edguez","year":"2025","journal-title":"Neurology (ECronicon)"},{"key":"2025101704150976000_18.10.e263621.8","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-009-5264-6"},{"key":"2025101704150976000_18.10.e263621.9","first-page":"TD08","article-title":"MRI in Chemotherapy induced Leukoencephalopathy: Report of Two Cases and Radiologist\u2019s Perspective","volume":"11","author":"Sindhwani","year":"2017","journal-title":"J Clin Diagn Res"},{"key":"2025101704150976000_18.10.e263621.10","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A5947"},{"key":"2025101704150976000_18.10.e263621.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.ncl.2008.03.007"},{"key":"2025101704150976000_18.10.e263621.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.jneuroim.2010.09.021"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2024-263621","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T11:15:21Z","timestamp":1760699721000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2024-263621"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10]]},"references-count":12,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10,17]]},"published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1136\/bcr-2024-263621"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2024-263621","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10]]}}}