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"Lack of knowledge is no excuse" HIV positive patient with progressive multifocal leukoencephalopathy. Case report
Jirina Kafkova1, Barbora Silharova2
1St. Elisabeth University College of Health and Social Sciences, Bratislava, Slovakia.
Abstract:
Progressive multifocal leukoencephalopathy (PML) is a severe demyelinating disease that affects the central nervous system, which has high morbidity and mortality and no effective, targeted therapies are available. According to the data from developing countries, it affects about 3 to 5% patients who are HIV positive. We present a case of a 27-year-old patient, who got infected with the HIV virus from his mother. The patient had poor compliance to the therapy since its initiation. Due to poor compliance and immunological and virological failure of the first line ARVs, the patient developed PML. Despite confirmed diagnosis of PML and change of the regimen to the second line ARVs, due to progression of the condition, he sought care of an unknown physician, who prescribed therapy with azathioprine 150 mg twice daily, which the patient used for more than 2 weeks. Despite immediate virological suppression, the condition significantly worsened, until the patient developed paraparesis, postural tremor, head tremor, severe dysarthria; he was not able to walk, eat or express himself. The major roadblocks to diagnosis of PML include poor access to health care in general, as well as poor knowledge of the rare condition among the health care professionals. Therapy with azathioprine has been proved to be associated with the development of PML. Thus, in resource limited settings, there is an urgent need for improved access to health care and imaging and laboratory diagnostic means, which would decrease the economic and social burden of severe conditions, such as PML.
Insights
Progressive multifocal leukoencephalopathy (PML), a severe brain disease affecting HIV patients, worsened significantly after azathioprine treatment. Early diagnosis and better healthcare access are crucial, especially in resource-limited settings.
Area of Science:
- Neuroscience
- Immunology
- Infectious Diseases
Background:
- Progressive multifocal leukoencephalopathy (PML) is a rare, severe demyelinating disease of the central nervous system with high morbidity and mortality.
- PML affects approximately 3-5% of individuals with Human Immunodeficiency Virus (HIV), particularly those with poor treatment adherence.
- Currently, there are no effective targeted therapies for PML, posing a significant challenge in patient management.
Observation:
- A case study of a 27-year-old HIV-positive patient with a history of poor antiretroviral therapy (ART) compliance who developed PML.
- Despite diagnosis and ART regimen change, the patient's condition progressed, leading to neurological deficits.
- The patient was prescribed azathioprine, which, despite initial virological suppression, exacerbated PML symptoms, resulting in severe disability.
Findings:
- Azathioprine therapy has been linked to the development and worsening of PML.
- Poor access to healthcare and limited knowledge of PML among healthcare professionals are major diagnostic barriers.
- The case highlights the critical need for improved diagnostic tools and healthcare access in resource-limited settings.
Implications:
- This case underscores the importance of careful medication review in immunocompromised patients, particularly regarding immunosuppressive drugs like azathioprine.
- Enhanced diagnostic capabilities, including advanced imaging and laboratory tests, are essential for timely PML diagnosis and management.
- Addressing healthcare access disparities and improving professional awareness are vital to reduce the burden of severe neurological conditions like PML.
