229 - Progressive Multifocal Leukoencephalopathy in a 74-Year-Old Male Following Bone Marrow Transplant, An Important Consideration In Cancer Rehabilitation: A Case Report

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

SF

Stephanie Fortune, DO

Resident Physician
University of Kansas
Kansas City, Kansas, United States

Corresponding Author(s)

EQ

Evelyn Qin, MD, MPH

Assistant Professor, Medical Director of Oncology Rehabilitation
University of Kansas Medical Center
Kansas City, Kansas, United States

Co-Author(s)

SD

Sam Detwiler, MD

Resident Physician
University of Kansas
Westwood, Kansas, United States
JG

Josh Gassmann, MD

Resident Physician
University of Kansas
Kansas City, Kansas, United States

Submitter(s)

SF

Stephanie Fortune

Case Diagnosis: Progressive Multifocal Leukoencephalopathy (PML) due to JC Virus Infection in the Setting of Bone Marrow Transplant

Case Description: A 73-year-old with aplastic anemia underwent allogeneic bone marrow transplant. Eleven months after transplant, patient initially experience abnormal neurological signs and symptoms including ataxia, scanning speech, minimal dysarthria, hyperreflexia. He underwent thorough workup, and initially was treated with IVIG and high dose corticosteroids with mild improvement in dysarthria, however no clear diagnosis was established. Symptoms progressed over two months without notable findings in infectious/autoimmune/neurologic workup. Though serum testing was positive for EBV and JC virus, cerebrospinal fluid testing was negative, thus PML was deemed a less likely etiology. MRI imaging revealed progression of FLAIR hyperintensities, with brain biopsy obtained, positive for JC virus. Patient was subsequently diagnosed with PML, and underwent inpatient rehabilitation with ongoing complicated rehabilitation course in the setting of progressive disease.

Discussions: This case represents an immunocompromised patient with a challenging workup and diagnosis of a progressive neurologic disease. PML caused by JC virus re-activation is a devastating complication in immunosuppressed patients, which applies to a large percentage of cancer rehabilitation patients. There is usually rapid deterioration and high mortality with survival typically less than six months. There is significant value in early diagnosis of this progressive neurologic disease to provide appropriate early physical, occupational, and speech therapy to optimize patients’ rehabilitation courses.

Conclusions: In immunosuppressed patients such as this patient status post bone marrow transplant, timing of initial diagnosis of progressive neurologic disease including PML is important to consider. Early diagnosis can lead to earlier intervention with involvement of physiatry and therapy team members. Early intervention may positively impact the patient in several ways, including optimizing function as the progressive disease takes its course, providing an extended period of improved quality of life for the patient and their family/caretakers.