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Inflammatory progressive multifocal leukoencephalopathy with human T-cell lymphotropic virus-1 coinfection

Sachiko Hasebe1, Kota Maekawa2, Yukiko Shishido-Hara3

  • 1Department of Neurology, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan sachiko_h@kuhp.kyoto-u.ac.jp.

BMJ Case Reports
|April 30, 2024
PubMed

Insights

This case highlights progressive multifocal leukoencephalopathy (PML) in an HTLV-1 carrier. Early detection of JC virus (JCV) and HTLV-1 is crucial for managing this rare brain inflammation.

Area of Science:

  • Neurovirology
  • Immunology

Background:

  • Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating disease.
  • Human T-cell lymphotropic virus type-1 (HTLV-1) carriers are susceptible to opportunistic infections.

Observation:

  • A middle-aged man on haemodialysis with HTLV-1 presented with dysarthria and ataxia.
  • Brain MRI showed asymmetric white matter lesions; JC virus (JCV) DNA confirmed in CSF and cerebellar biopsy.
  • Pathology revealed demyelination, glial changes, and inflammatory cell infiltration with a CD4+/CD8+ ratio of 0.83.

Findings:

  • High-dose corticosteroids reduced inflammation.
  • Mefloquine and mirtazapine treatment led to a favorable outcome.
  • Encephalitis was secondary to JCV infection in the context of HTLV-1.

Implications:

  • Investigating HTLV-1 is vital for diagnosing the cause of brain inflammation.
  • This case underscores the importance of considering co-infections in neurological conditions.
  • Effective management strategies involve addressing both the viral infection and inflammation.
Keywords:
Brain stem / cerebellumInfection (neurology)

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