2754 A case of JCV encephalitis in an immune-compromised patient treated with allogeneic JCV-specific cytotoxic T lymphocytes

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Background JCV encephalitis is a rare manifestation of JC virus infection of the CNS in immunocompromised individuals. There are a few emerging treatments in this domain, including CD8+ Cytotoxic T lymphocytes grown specifically to target JCV infected cells. While there are case reports of its use in patients with PML (progressive multifocal leukoencephalopathy), studies in management of JCV encephalitis are lacking.Presentation We describe the case of a 66-year-old woman presenting with rapid cognitive decline involving multiple domains, on a background of CLL, secondary myelodysplasia and pyoderma gangrenosum managed with immunosuppression including prednisolone and mycophenolate. Further evaluation revealed atypical multifocal cortical FLAIR signal abnormalities on MRI Brain imaging, and an elevated CSF JC viral load (3245 IU/ml), leading to the diagnosis JCV encephalitis.Management Initial management was with withdrawal of immunosuppression. She subsequently underwent HLA typing and infusion of JCV specific CD8+ Cytotoxic T lymphocytes with weekly infusions over 4 weeks. On follow up at 3 months from initial presentation and at 2 weeks following treatment completion, the CSF JC viral load had reduced significantly (223 IU/ml), inflammatory changes identified on imaging had stabilised and the deterioration in cognition had halted, however the patient remained significantly disabled.Discussion This case demonstrates the first described case of JCV encephalitis treated with Cytotoxic T lymphocytes. The outcome was radiological and virologic improvement, accompanied by clinical stabilisation within 2 weeks of treatment completion. This case highlights the importance of early recognition and potential novel treatment options for this disabling and usually fatal infection.

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