Progressive multifocal leukoencephalopathy - immune reconstitution inflammatory syndrome (PML-IRIS) in liver transplant recipient.

65-year-old liver transplant recipient presented with progressive neurologic dysfunction. CSF analysis revealed high JC virus load and MRI findings suggested the diagnosis of progressive multifocal leukoencephalopathy (PML). Cidofovir and mirtazapine were initiated and patient's regular immunosuppressants were reduced. Subsequently patient developed left sided hemiplegia, drowsiness and severe neglect syndrome. MRI revealed enlargement of PML lesions with contrast enhancement and worsening of oedema, consistent with immune reconstitution inflammatory syndrome (IRIS). Steroids were initiated and 3 weeks later patient showed moderate neurologic improvement. PML-IRIS after solid organ transplantation is rarely detected and to the best of our knowledge, this is the first reported case of PML-IRIS in a liver transplant recipient.