case_images: PMC11135084_01
case_images: Clinical and laboratory follow-up parameters. (a) JCV viral load (red) and pNFL concentration (blue) on multiple time points since therapy. Black arrows: Times of DIAVIS T-cell infusion. (b) NIHSS score on multiple time points since therapy initiation. Black arrows: Times of DIAVIS T-cell infusion. The score was determined retrospectively on the basis of available neurological examination results. (c) These photographs show the severe clinical condition of the patient, with the left image taken before the initiation of DIAVIS BKV and EBV T-cell treatment, and the right image captured 19 weeks following the commencement of therapy. The photographs were taken by the patient's relatives. We have obtained the patient's consent to share these photographs. (d) T2*-weighted MRI image before, during, and after therapy initiation. Despite initiation of HAART, the MRI revealed PML progression with enlarging lesions prior to therapy initiation, consistent with the clinical deterioration. After initiation of therapy with DIAVIS BKV and EBV T-cells in mid-January 2023, the lesions showed a steady regression.. DIAVIS T-cells, directly isolated allogeneic virus-specific T-cells; HAART, highly active antiretroviral therapy; JCV, human polyomavirus 2; MRI, magnetic resonance imaging; NIHSS, National Institutes of Health Stroke Scale; PML, progressive multifocal leukoencephalopathy; pNFL, plasma neurofilament light chain.
case_images: 10.1177_17562864241253917-fig1.jpg
case_images: PMC11135084_01_10.1177_17562864241253917-fig1.jpg
case_images: fig1-17562864241253917
case_images: MRI also showed progression of PML with enlargement of PML-typical parenchymal changes, particularly in the thalami and midbrain [Figure 1(d)]. MRI features suggestive of IRIS were still absent. Six weeks following the commencement of treatment, significant neurological improvements were observed in the patient [Figure 1(c)]. Figure 1 and Table 2 display the clinical and laboratory results throughout the course of treatment. Proximal weakness persisted in his left leg, but he could move independently and walk over 100 m [Figure 1(b)]. Brain MRI indicated partial resolution of T2-hyperintensities particularly in the right thalamic area without new lesions [Figure 1(d)]. EBV was undetectable in the CSF, and no JCV DNA was found after therapy initiation [Figure 1(a)].