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Inflammatory progressive multifocal leukoencephalopathy in human immunodeficiency virus-negative patients

DeRen Huang1, Michael Cossoy, Meizhang Li

  • 1Department of Neurology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA. huangd2@ccf.org

Annals of Neurology
|March 1, 2007
PubMed
Abstract

Insights

Inflammatory progressive multifocal leukoencephalopathy (iPML) with enhancing MRI lesions occurs in HIV-positive patients on HAART and HIV-negative individuals. This suggests current MRI criteria for PML may need revision.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Radiology

Background:

  • Progressive multifocal leukoencephalopathy (PML) with enhancing magnetic resonance imaging (MRI) lesions and leukocyte infiltration is observed in human immunodeficiency virus (HIV)-infected individuals post-highly active antiretroviral therapy (HAART).
  • Current MRI diagnostic criteria for PML suggest iPML is exclusive to HIV-positive individuals.

Purpose of the Study:

  • To investigate the occurrence and characteristics of iPML in HIV-negative individuals compared to HIV-positive individuals on HAART.
  • To evaluate the diagnostic criteria for PML based on MRI findings.

Main Methods:

  • Pathologically confirmed cases of PML were analyzed, including those diagnosed via biopsy, MRI, and autopsy.
  • Enhancing MRI lesions and CD3(+) lymphocyte infiltration were assessed in both HIV-negative and HIV-positive patients.

Main Results:

  • Enhancing MRI lesions, indicative of iPML, were found in both HIV-negative and HIV-positive patients, correlating with CD3(+) lymphocyte infiltration.
  • Inflammatory infiltrates were prevalent in most HIV-negative and HIV-positive/HAART cases, but rare in HIV-positive/non-HAART cases.

Conclusions:

  • Inflammatory PML (iPML) exhibits radiographic and pathological similarities between HIV-positive patients on HAART and HIV-negative individuals.
  • The findings challenge existing MRI criteria for PML, indicating a need for re-evaluation to include HIV-negative cases of iPML.

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