Progressive multifocal leukoencephalopathy presenting as IRIS in an AIDS patient. A case report and literature review.

Progressive multifocal leukoencephalopathy causes an infection of the central nervous system by JC virus (JCV), a polyomavirus that destroys oligodendrocytes and their myelin processes. Here, we describe a patient with AIDS who developed a progressive multifocal leucoencephalopathy with the clinical and neuroimaging characteristics of the immune inflammatory reconstitution syndrome. Unlike other opportunistic infections, this disease can present when CD4 T cell counts are higher than those associated with AIDS and also when patients are receiving combined antiretroviral therapy. Clinical suspicion of this form of the disease is based on clinical examination that shows focal neurological deficits associated with magnetic resonance images findings. The histopathological examination of brain biopsy smears and the identification of JCV in cerebrospinal fluid or brain tissue are definitive for the diagnosis.

Central nervous system immune reconstitution inflammatory syndrome in AIDS: experience of a Mexican neurological centre.

BACKGROUND: Highly active antiretroviral therapy (HAART) restores the inflammatory immune response in AIDS patients and it may unmask previous subclinical infections or paradoxically exacerbate symptoms of opportunistic infections. Up to 25% of patients receiving HAART develop immune reconstitution inflammatory syndrome (IRIS). We describe six patients with IRIS central nervous system (CNSIRIS) manifestations emphasizing the relevance of CSF cultures and neuroimaging in early diagnosis and management. METHODS: Patients with CNSIRIS were identified among hospitalized HIV-infected patients that started HAART from January 2002 through December 2007 at a referral neurological center in Mexico. RESULTS: One-hundred and forty-two HIV-infected patients with neurological signs were hospitalized, 64 of which had received HAART, and six (9.3%) developed CNSIRIS. Five patients were male. Two cases of tuberculosis, two of cryptococcosis, one of brain toxoplasmosis, and one possible PML case were found. IRIS onset occurred within 12 weeks of HAART in five patients. Anti-infective therapy was continued. In one case, HAART was temporarily suspended. In long-term follow-up the clinical condition improved in all patients. CONCLUSIONS: CNSIRIS associated to opportunistic infections appeared in 9% of patients receiving HAART. Interestingly, no cases of malignancy or neoplasm IRIS-related were found. Frequent clinical assessment and neuroimaging studies supported diagnosis and treatment. Risk factors were similar to those found in other series.

Progressive multifocal leukoencephalopathy restricted to the posterior fossa in a patient with systemic lupus erythematosus

Progressive multifocal leukoencephalopathy is a neurological infectious disease caused by the John Cunningham polyomavirus (JCV), an opportunistic agent with worldwide distribution. This disease is frequently seen in immunosuppresed patients and rarely associated with systemic lupus erythematosus. In the central nervous system PML demyelinating lesions occur in the supratentorial compartment. The authors describe a rare case of PML secondary to SLE treatment with atypical presentation restricted to the posterior fossa.

Progressive multifocal leukoencephalopathy as an AIDS-defining condition in a patient with high CD4+ T-lymphocyte count.

We present the case of a 31-year-old man with acute manifestation of progressive multifocal leukoencephalopathy (PML) as an AIDS-defining disease. The patient presented with a three-day history of neurological disease, brain lesions without mass effect or contrast uptake and a slightly increased protein concentration in cerebrospinal fluid. A serological test for HIV was positive and the CD4+ T-cell count was 427/mm³. Histological examination of the brain tissue revealed abnormalities compatible with PML. The disease progressed despite antiretroviral therapy, and the patient died three months later. PML remains an important cause of morbidity and mortality among HIV-infected patients.

Progressive multifocal leukoencephalopathy as an AIDS-defining condition in a patient with high CD4+ T-lymphocyte count / Leucoencefalopatia multifocal progressiva como condição definidora de AIDS em paciente com contagem alta de linfócitos T CD4

We present the case of a 31-year-old man with acute manifestation of progressive multifocal leukoencephalopathy (PML) as an AIDS-defining disease. The patient presented with a three-day history of neurological disease, brain lesions without mass effect or contrast uptake and a slightly increased protein concentration in cerebrospinal fluid. A serological test for HIV was positive and the CD4+ T-cell count was 427/mm³. Histological examination of the brain tissue revealed abnormalities compatible with PML. The disease progressed despite antiretroviral therapy, and the patient died three months later. PML remains an important cause of morbidity and mortality among HIV-infected patients.

Apresentamos o caso de um homem de 31 anos com leucoencefalopatia multifocal progressiva (LMP) de manifestação aguda como doença definidora de AIDS. O paciente apresentou-se com doença neurológica com três dias de evolução, lesões encefálicas sem efeito de massa ou captação de contraste e leve aumento de proteínas no líquor. Sorologia para o HIV foi positiva e a contagem de linfócitos T CD4+ era de 427/mm³. O exame histológico de tecido cerebral revelou alterações compatíveis com LMP. A doença progrediu a despeito da terapia antirretroviral, e o paciente morreu após três meses. LMP permanece como causa relevante de mortalidade e morbidade em pacientes infectados pelo HIV.

Progressive multifocal leukoencephalopathy restricted to the posterior fossa in a patient with systemic lupus erythematosus.

Progressive multifocal leukoencephalopathy is a neurological infectious disease caused by the John Cunningham polyomavirus (JCV), an opportunistic agent with worldwide distribution. This disease is frequently seen in immunosuppressed patients and rarely associated with systemic lupus erythematosus. In the central nervous system PML demyelinating lesions occur in the supratentorial compartment. The authors describe a rare case of PML secondary to SLE treatment with atypical presentation restricted to the posterior fossa.

Leucoencefalopatia multifocal progressiva / Progressive multifocal leucoencephalopathy

A ocorrência de infecções oportunistas no sistema nervoso central, em pacientes imunossuprimidos é comum e reconhecida há longo tempo. Relata-se caso de Leucencefalopatia Multifocal Progressiva em paciente de 28 anos, HIV positivo, doença em estágio terminal. São discutidos os aspectos clínico-radiológicos, imunopatológicos e prognósticos dessa afecção, apoiados na literatura especializada

Tuberculoma cerebral como manifestaçäo neurológica no curso de uma infecçäo pelo HIV: relato de caso e revisäo da literatura / Tuberculomas of the CNS in HIV-infection: case report and review of literature

À medida que a sobrevida dos doentes com infecção pelo HIV aumenta, as complicações neurológicas tornam-se mais prevalentes. O reconhecimento imediato de algumas destas é muito importante visto que a demora do diagnóstico e do início do tratamento são fatores que pioram sua evolução. Descrevemos um caso de tuberculoma cerebral em paciente HIV positivo que vinha em profilaxia com isoniazida. A evolução desfavorável em vigência do tratamento para toxoplasmose e os achados liquóricos foram os indícios mais importantes de que as lesões cerebrais eram tuberculomas. Comparamos as lesões antes e após o tratamento para tuberculoses através da ressonância magnética nuclear, documentando sua melhora. Os autores revisam ainda as manifestações neurológicas focais da síndrome da imunodeficiência adquirida, enfocando principlamente a tuberculose cerebral. Concluímos que os tuberculomas cerebrais devem sempre ser lembrados naqueles pacientes com lesões encefálicas focais que não respondem adequadamente ao tratamento para toxoplasmose cerebral, tanto pela forte prevalência da tuberculose em nosso meio quanto pelas implicações prognósticas desfavoráveis se o diagnóstico e a terapêutica forem retardados.

Neurologic manifestations of AIDS: a comparative study of two populations from Mexico and the United States.

Neurologic complications associated with human immunodeficiency virus type 1 (HIV-1) infection vary geographically. To understand the pattern of HIV-associated neurologic complications in Mexico, 120 AIDS patients from Mexico City, Mexico, and 500 AIDS patients from Houston, Texas, were studied cross-sectionally and retrospectively. Neurologic, laboratory, imaging, and pathologic examinations identified 40 Mexican patients and 130 U.S. patients with neurologic complications. Whereas AIDS dementia complex was the most common neurologic manifestation in both groups, intracranial tuberculoma was present only in the Mexican population (10%). Primary brain lymphoma was more prevalent in the U.S. population (8.4%). The different findings in the Mexican population likely reflect afflictions common to developing countries--a high prevalence of tuberculosis and a high mortality rate. These conditions preclude complications such as lymphoma, which develop later in the natural course of HIV infection.

Sudden appearance of multiple brain lesions in Aids after a cerebral biopsy. Case report

A unique case of cerebral toxoplasmosis which had an acute appearance of multiple discrete lesions following a biopsy and its neuroradiological findings are reported in detail. Possible pathophysiological mechanism are presented

Sudden appearance of multiple brain lesions in Aids after a cerebral biopsy. Case report.

A unique case of cerebral toxoplasmosis which had an acute appearance of multiple discrete lesions following a biopsy and its neuroradiological findings are reported in detail. Possible pathophysiological mechanism are presented.

Leucoencefalopatia multifocal progresiva y síndrome de inmunodeficiencia adquirida (SIDA) / Progressive multifocal leukoencephalopathy and acquired immunodeficiency syndrome (AIDS)

La LMP es una enfermedad infrecuente del sistema nervioso central, de tipo desmielinizante y de origen viral (Papova JC) que afecta a pacientes inmunodeprimidos. El SIDA se ha sumado a las afecciones que favorecen el desarollo de la LMP, debido al trastorno inmune que ocasiona. Se relata el caso de un enfermo de 45 años, con criterios clínicos, epidemiológicos y serológicos de infección por HIV, que padeció en su evolución un cuadro neurológico de pogresión subaguda. La clínica y los exámenes complementarios orientaron el diagnóstico de LMP. Esta presunción fue confirmada histológicamente, detectandose el agente causal en las lesiones. Se destaca, asimismo, la asociación de una entidad infrecuente (LMP), con otra de interés creciente (SIDA) en nuestro medio

Leucoencefalopatia multifocal progresiva y síndrome de inmunodeficiencia adquirida (SIDA) / Progressive multifocal leukoencephalopathy and acquired immunodeficiency syndrome (AIDS)

La LMP es una enfermedad infrecuente del sistema nervioso central, de tipo desmielinizante y de origen viral (Papova JC) que afecta a pacientes inmunodeprimidos. El SIDA se ha sumado a las afecciones que favorecen el desarollo de la LMP, debido al trastorno inmune que ocasiona. Se relata el caso de un enfermo de 45 años, con criterios clínicos, epidemiológicos y serológicos de infección por HIV, que padeció en su evolución un cuadro neurológico de pogresión subaguda. La clínica y los exámenes complementarios orientaron el diagnóstico de LMP. Esta presunción fue confirmada histológicamente, detectandose el agente causal en las lesiones. Se destaca, asimismo, la asociación de una entidad infrecuente (LMP), con otra de interés creciente (SIDA) en nuestro medio (AU)