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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.
Revista Clinica Espanola
|January 1, 1994
Summary
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.