{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T07:22:16Z","timestamp":1778138536143,"version":"3.51.4"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:p>Progressive multifocal leukoencephalopathy (PML) is a rare and often fatal demyelinating disease of the central nervous system (CNS) caused by the reactivation of the JC polyomavirus (JCPyV). While PML is a known complication of hematological malignancies, it is exceedingly rare for it to manifest as the initial neurological symptom of a relapsed lymphoma, occurring even before the start of new systemic chemotherapy. We present a case of a 22-year-old male with a history of lymphoma who presented with progressive neurological deficits. The patient\u2019s symptoms, including right-sided hemiparesis and aphasia, were initially mistaken for a CNS lymphoma relapse. Subsequent chemotherapy led to a rapid and severe clinical deterioration. Cerebrospinal fluid testing detected a high viral load of JCPyV. The patient underwent a brain biopsy, which revealed inflammatory changes consistent with the pathological changes of PML. This case highlights a critical diagnostic challenge and underscores the need for a high index of suspicion for PML in any immunocompromised patient with new-onset neurological symptoms, regardless of whether they have commenced new immunosuppressive therapy. It also serves as a poignant reminder of the potential for chemotherapy to exacerbate an underlying viral pathology.<\/jats:p>","DOI":"10.3389\/fonc.2026.1710057","type":"journal-article","created":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T05:33:30Z","timestamp":1771392810000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Progressive multifocal leukoencephalopathy as the initial manifestation of relapsed lymphoma: a case report"],"prefix":"10.3389","volume":"16","author":[{"given":"Shi","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Neurology, Xuanwu Hospital, Capital Medical University","place":["Beijing, China"]},{"name":"Department of Neurology, Chifeng Municipal Hospital","place":["Chifeng, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haitian","family":"Nan","sequence":"additional","affiliation":[{"name":"Department of Neurology, Xuanwu Hospital, 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