The Virus of John Cunningham

The Virus of John Cunningham

A few years ago, I was seeing a new patient in the Infectious Disease clinic. It was an African American male in his early forties. He had recently been admitted to the hospital with pneumonia. This was also found to have advanced HIV infection. His pneumonia was treated and he had been referred to me for further treatment of his HIV infection.

He was an extremely nice man, but was not sure how or when he got the virus. He did not use drugs, held a steady job and was married with three children. His wife was negative for the infection even though he had likely been infected for many years prior to marrying her.

On the first visit, he was accompanied by his wife. She was Caucasian and much younger than him. She appeared very devoted to him and was quite concerned about him. They were accompanied by their youngest child, a two-year-old daughter.

I explained the disease to them in detail as well as the precautions that they need to take in order to prevent him from passing the infection to his wife. I then started him on a cocktail of medications after explaining their potential side effects.

My patient started his regimen. He was very compliant and his virus levels fell rapidly and soon became undetectable. His immune system also started to recover. I was quite excited and remember congratulating him on a subsequent visit.

However, one week after that visit, he came back to the clinic. Strange things were happening to him. His wife told me he could not remember things and was dropping objects. His speech had become slurred and he was having difficulty walking.

Alarmed, I admitted him to the hospital and ordered an MRI of his brain. His MRI showed multiple patchy white areas on his brain. These were the likely cause of his symptoms. At this point I thought it best to transfer him to our nearby teaching hospital, as they would have more facilities to make a diagnosis. A few days later, I received a call from the Infectious Disease Professor who was taking care of him. They had made a diagnosis of Progressive Multifocal Leukoencephalopathy or PML for short.

PML is a deadly disease that is associated with severe immunosuppression that occurs in advanced HIV patients. The disease is caused by a virus, known as the JC virus. JC stands for John Cunningham and is the name of the first patient in whom this virus was isolated. This virus is harmless in most people except those with advanced immune deficiencies, such as in cancer or HIV infection, in which case it can be fatal.

John Cunningham was the first patient in whom this disease was described. He was a 36-year-old military veteran who had developed a cancer. While receiving chemotherapy for the cancer, he developed inexplicable neurological problems and subsequently died. A virus was isolated from his brain tissue and was given his name. The year was 1970.

Fifteen years later, the JC virus made a resurgence amongst advanced HIV patients. It often surfaces when the immune system is starting to recover after HIV therapy is started, as it happened in my patient. There is no specific treatment. My patient continued to decline and was moved to a nursing home. He died there a few weeks later.

I thought hard about this patient’s treatment and if I could have done anything differently. There was nothing I could find. I spoke to his distraught wife afterwards and did my best to comfort her. She would now have to bring up their three children on her own.

John Cunningham would never have imagined that his name would become immortal by being given to the cause of the very illness that took his life, and that of many others.

                                           White patchy areas of PML on an MRI of the brain.