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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
Summary
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.
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