Progressive multifocal leukoencephalopathy as a rare first manifestation of AIDS: case report

Progressive multifocal leukoencephalopathy (PML) is a lethal demyelinating disease of the central nervous system caused by John Cunningham virus (JCV). PML develops due to the reactivation of latent JCV infection in individuals with cellular immunodeficiency. Since the beginning of acquired immunodeficiency syndrome (AIDS) epidemic, human immunodeficiency virus (HIV) infection has remained a leading cause of PML with the condition recognized as an AIDS-defining illness. The clinical manifestations of PML may vary depending on the underlying condition. In AIDS-associated PML, the symptoms include motor weakness, speech or language disturbances, cognitive and behavioral changes and gait abnormalities and incoordination.

We present the case of a male patient who developed PML as the first clinical manifestation of a newly diagnosed HIV infection.

The introduction of antiretroviral therapy has led to a significant decrease in the morbidity and mortality due to the opportunistic infections in HIV-positive patients. However, the improvement is least pronounced in case of PML.