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BACKGROUND Progressive multifocal leukoencephalopathy, (PML) a demyelinating disease of the brain, caused by the John Cunningham (JC Virus) is usually seen in patients who are immunocompromised. Here, we describe a case of an immunocompetent patient diagnosed with PML and a comprehensive literature review. CASE DESCRIPTION A 64-year-old Caucasian male presented with acute worsening of progressive neurological decline with difficulty in vision and reading. Based on history, examination, CSF markers, histopathology, and MRI Brain at the time of presentation diagnosed the patient with PML in a setting of no immunosuppression disorder. Patient was started on Pelfilgrastim with significant systematic improvement. RESULT In our literature review, it was seen that the average age of symptom presentation was 57.5 with predominance in males. Most of the patients presented with progressive neurological deficits with symptomology ranging from mild confusion, aphasia, anxiety to sensory disturbances with numbness, hemiparesis and hemianopsia. Out of the 21 cases, patients responded to mirtazapine and intravenous pulse methylprednisolone (IVMP). The mortality rate was close to 50% with 11 fatal cases and 10 non-fatal cases. CONCLUSION Our case and literature review demonstrate the possibility that PML may very rarely occur in patients that our immunocompetent. Furthermore, our review showed that patients responded well to mirtazapine and IVMP. We also want to highlight that mortality rate was lower in this review and was only compared to morality in PML associated with immunocompromised status. This article is protected by copyright. All rights reserved.

Background and purpose Previous cross-sectional studies have reported the involvement of thalamus, pallidum, superior cerebellar peduncle, temporal cortex, and fronto-parietal white matter in multiple sclerosis (MS)-related fatigue. However, the longitudinal imaging correlates of fatigue severity variation in MS remain unclear. Methods Structural and diffusion tensor imaging (DTI) data were collected from 43 relapsing remitting MS (RRMS) patients with fatigue (Fatigue Severity Scale [FSS] range: 1-7). Subcortical nuclei volume using FreeSurfer and cortical diffusion indices using a cross-modality technique were measured at baseline and year 1. Results The pallidal volume had significantly decreased (P = .002) by year 1, although the fatigue score variation was not significant. At year 1, the pallidal volume (P = .023) and fractional anisotropy (FA, P = .013) of right temporal cortex (RTC) correlated significantly with FSS. Conclusions The pallidal volume and the FA-RTC may be used to evaluate longitudinal fatigue severity variation. Our study proposes new biomarkers to monitor fatigue severity in MS patients.