Progressive Multifocal Leukoencephalopathy in HIV-Infected Children: A Case Report and Literature Review

Area of Science:

• Neurology
• Infectious Diseases
• Pediatrics

Background:

• Perinatally HIV-infected children are at risk for neurological complications.
• Early and effective antiretroviral therapy is crucial for managing HIV.
• Immune Reconstitution Inflammatory Syndrome (IRIS) can complicate HIV treatment.

Observation:

• A 9-year-old patient with perinatally acquired HIV presented with right-sided hemiplegia.
• Initial laboratory findings revealed severe immunosuppression (CD4 T-cell 0.21%) and high viral load (HIV RNA 185,976 copies/mL).
• Cerebrospinal fluid (CSF) and plasma tested positive for John Cunningham virus (JCV).

Findings:

• Magnetic Resonance Imaging (MRI) demonstrated progressive white matter lesions in the left frontotemporoparietal region and right frontal lobe following HAART initiation.
• The patient's neurological condition worsened despite treatment for suspected IRIS with methylprednisolone.
• JCV co-infection was identified in both plasma and CSF samples.

Implications:

• This case highlights a severe neurological presentation in a perinatally HIV-infected child, potentially linked to JCV.
• The findings underscore the complex interplay between HIV, IRIS, and opportunistic infections like JCV.
• Further research is needed to understand and manage neurological complications in vertically HIV-infected individuals, especially in the context of HAART and IRIS.