PML-IRIS in an HIV-2-infected patient presenting as Bell's palsy

Area of Science:

• Neuroimmunology
• Infectious Diseases
• Neurology

Background:

• Human Immunodeficiency Virus type 2 (HIV-2) infection is less common than HIV-1 but can lead to significant neurological complications.
• Progressive Multifocal Leukoencephalopathy (PML) is a rare demyelinating disease of the central nervous system caused by the JC virus, typically seen in severely immunocompromised individuals.
• Immune Reconstitution Inflammatory Syndrome (IRIS) can occur in patients starting antiretroviral therapy, leading to paradoxical worsening of opportunistic infections.

Observation:

• A case of an HIV-2-infected patient experiencing neurological symptoms consistent with Bell's palsy is presented.
• Brain Magnetic Resonance Imaging (MRI) revealed a single lesion in the facial colliculus.
• The lesion was initially misdiagnosed as ischemic in nature, highlighting diagnostic challenges.

Findings:

• The patient was diagnosed with Progressive Multifocal Leukoencephalopathy (PML) in the context of Immune Reconstitution Inflammatory Syndrome (IRIS).
• This case demonstrates that PML can manifest in HIV-2 positive individuals, contrary to common assumptions.
• The presentation as Bell's palsy and a single brain lesion complicated the early diagnosis of PML.

Implications:

• Clinicians should maintain a high index of suspicion for PML in HIV-2 patients presenting with neurological deficits, including facial palsy.
• This case underscores the importance of considering PML in the differential diagnosis of neurological abnormalities in HIV-2 infected individuals, especially during IRIS.
• Improved diagnostic strategies are needed to accurately and timely diagnose PML in the setting of HIV-2 and IRIS to ensure appropriate management.