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[Progressive multifocal leukoencephalopathy in acquired immunodeficiency syndrome]
A Clavo Sánchez1, D García-Gil, S Sasián Martínez
1Unidad de Enfermedades Infecciosas, Hospital Universitario Puerta del Mar, Cádiz.
Abstract:
Progressive multifocal leukoencephalopathy (PML) is a rare opportunistic infection in HIV-infected persons. We present the characteristics of seven cases of PML, which represent 3.1% of our patients with AIDS. In six cases, was the "marker" disease for AIDS. The most common clinical manifestation was a slowly evolving focal neurological syndrome (average time of pre-hospitalization symptoms was 64 days). The number of T4 lymphocytes at the moment of diagnosis varied between 14 and 121 cel/mm3 (median: 51). Computerized tomography (CT) and cranial nuclear magnetic resonance (NMR) showed images of single (4 cases) or multiple white substance involvement without contrast uptake or mass-effect. The definitive diagnosis was made by cerebral biopsy. Four died within 20 to 90 days of diagnosis. Three of the five who received antiretrovirals survived with apparent stabilization of the process at 2, 13, and 23 months of diagnosis. PML can be an initial diagnostic disease for AIDS. Its symptoms and the CT/NMR should arouse suspicion. However, given that clinicoradiological data are often insufficient, it is advisable to conduct cerebral biopsies. Antiretrovirals may have a favorable effect on diseases course.
Insights
Progressive multifocal leukoencephalopathy (PML) is a rare opportunistic infection in HIV-infected individuals, often indicating AIDS. Early diagnosis via imaging and biopsy, alongside antiretroviral therapy, may improve patient outcomes.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Context:
- Progressive multifocal leukoencephalopathy (PML) is a rare opportunistic infection in HIV-infected individuals.
- PML represented 3.1% of AIDS cases in this cohort.
- In most cases, PML served as the initial diagnostic marker for AIDS.
Purpose:
- To characterize the clinical presentation, diagnostic findings, and outcomes of PML in HIV-infected patients.
- To evaluate the role of antiretroviral therapy in managing PML in this population.
Summary:
- Seven cases of PML in HIV-infected individuals were analyzed.
- The most common symptom was a slowly progressing focal neurological deficit.
- Diagnostic imaging (CT/NMR) showed white matter lesions without contrast enhancement or mass effect.
- Cerebral biopsy confirmed the diagnosis.
- Low T4 lymphocyte counts (median 51 cells/mm³) were observed.
- Four patients died within 20-90 days.
- Three patients receiving antiretrovirals showed apparent stabilization of the disease.
Impact:
- PML can be an initial diagnostic indicator for AIDS.
- Clinical and imaging findings should raise suspicion for PML.
- Cerebral biopsy is crucial for definitive diagnosis due to often insufficient clinicoradiological data.
- Antiretroviral therapy may positively influence the course of PML.