JC Virus Granule Cell Neuronopathy as AIDS-Presenting Illness

Area of Science:

• Neurovirology
• Immunocompromised Host Pathologies

Background:

• John Cunningham virus (JC virus) is a polyomavirus primarily known to cause progressive multifocal leukoencephalopathy (PML) in immunocompromised individuals.
• JC virus can also manifest as other neurological disorders, including encephalitis, meningitis, and granule cell neuronopathy (GCN).

Observation:

• A case of JC virus granule cell neuronopathy is presented in a patient with newly diagnosed acquired immune deficiency syndrome (AIDS).
• The patient's neurological symptoms preceded the diagnosis of human immunodeficiency virus (HIV) infection by several months.
• This presentation occurred without evidence of concurrent progressive multifocal leukoencephalopathy.

Findings:

• JC virus GCN can be an inaugural manifestation of AIDS-defining illness.
• Delayed diagnosis of HIV infection can complicate the management of JC virus-related neurological diseases.
• Cerebellar disease in the context of immunosuppression warrants consideration of opportunistic infections.

Implications:

• Highlights the diverse neurological presentations of JC virus beyond PML.
• Emphasizes the critical need for early HIV screening in patients presenting with unexplained neurological symptoms, especially cerebellar dysfunction.
• Underscores the importance of including JC virus opportunistic infections in the differential diagnosis for immunocompromised patients with neurological deficits.