Presumptive Progressive Multifocal Encephalopathy in an Immunocompetent Patient: A Rare Case Report

Progressive multifocal encephalopathy (PML) is a rare brain infection caused by the John Cunningham virus (JCV), primarily affecting immunocompromised individuals. This case report presents a unique occurrence of PML in an immunocompetent young man with a history of substance abuse. The patient exhibited progressive neurological symptoms, including weakness and sensory deficits, prompting diagnostic evaluation. Brain imaging and laboratory tests revealed evidence of PML, supported by a positive JCV antibody. Notably, HIV testing was negative. While PML is typically associated with immunosuppression, this case raises questions about potential connections between substance abuse and viral reactivation. The patient received treatment with intravenous methylprednisolone and underwent rehabilitation, emphasizing the challenging nature of PML management. This case highlights the importance of considering PML as a differential diagnosis, even in immunocompetent individuals, and underscores the need for further research into its rare presentations and associated risk factors.