Multiple drugs: Progressive multifocal leukoencephalopathy secondary to John Cunningham virus infection and lack of efficacy.

A 52-year-old woman developed progressive multifocal leukoencephalopathy (PML) due to a John Cunningham (JC) virus infection while undergoing immunosuppressant treatment for systemic sclerosis. She also did not respond to treatment with ganciclovir for the JC virus. The woman experienced various symptoms, including behavioral disturbances, decreased visuospatial orientation, and left hemiparesis. After stopping mycophenolate mofetil and continuing with a low dose of methylprednisolone, she received off-label treatment with IV immune-globulin, which slightly improved her communication and decreased apathy. A diagnosis of PML was confirmed through a positive PCR report for JC virus DNA in the cerebrospinal fluid. The woman then received ganciclovir for JC virus infection, but due to a worsening of symptoms and lack of efficacy, she was discharged and continued to receive IV immune-globulin infusions every month. Her condition significantly improved, with her MMSE score, visual acuity, and behavior returning to normal. [Extracted from the article]