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Acute Cerebellar Ataxia as the Presenting Symptom of Progressive Multifocal Leukoencephalopathy with HIV - A Case
Th Suraj Singh1, Kuldeep Singh1
1Department of General Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India.
Abstract:
A 45-year-old man presented with acute onset ataxia for last 1 week. On examination he had signs of left-sided cerebellar involement. MRI brain revealed asymmetric altered signal intensities in bilateral cerebellar hemispheres suggesting demyelinating lesions. ELISA for Human Immune Deficiency virus-1 was positive. CSF JC virus DNA PCR was positive. A diagnosis of Progressive Multifocal Leukoencephalopathy (PML) was made on the basis of clinico-radiological picture and JC virus DNA PCR presence in CSF. PML is unknown and under diagnosed CNS infection seen in HIV patients mostly seen with advanced disease. We present an unusual case report where isolated cerebellar involvement occurred as the first AIDS defining event in the absence of appreciable immunodeficiency in a patient with previously undiagnosed HIV infection.
Insights
A 45-year-old man with undiagnosed HIV developed acute ataxia due to Progressive Multifocal Leukoencephalopathy (PML). This case highlights PML as an unusual initial AIDS-defining event with isolated cerebellar symptoms.
Area of Science:
- Neuroscience
- Infectious Diseases
- Immunology
Background:
- Progressive Multifocal Leukoencephalopathy (PML) is a rare, opportunistic infection of the central nervous system (CNS).
- PML is typically associated with advanced Human Immunodeficiency Virus (HIV) infection and significant immunodeficiency.
- It is often underdiagnosed and presents with diverse neurological manifestations.
Observation:
- A 45-year-old man presented with sudden onset ataxia and left-sided cerebellar signs.
- Brain MRI revealed asymmetric demyelinating lesions in the cerebellar hemispheres.
- Initial diagnostic tests were positive for HIV-1 infection and JC virus DNA in cerebrospinal fluid (CSF).
Findings:
- The patient was diagnosed with PML based on clinical presentation, neuroimaging, and positive JC virus PCR in CSF.
- This case is unusual as isolated cerebellar involvement was the first recognized AIDS-defining illness.
- The patient presented without significant, clinically apparent immunodeficiency prior to diagnosis.
Implications:
- This case underscores the importance of considering PML in HIV-infected individuals presenting with neurological symptoms, even with minimal apparent immunodeficiency.
- It highlights the potential for PML to manifest with atypical, isolated cerebellar presentations.
- Early diagnosis and management of PML in HIV patients are crucial for patient outcomes.
