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Open Access 01-12-2020 | Toxoplasmosis | Case Report

Progressive multifocal leukoencephalopathy in an HIV patient was diagnosed by 3 times lumbar punctures and 2 times brain biopsies

Authors: Mengyan Wang, Zhongdong Zhang, Jinchuan Shi, Hong Liu, Binhai Zhang, Jun Yan

Published in: Journal of NeuroVirology | Issue 6/2020

Abstract

Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating disease of the central nervous system caused by JC virus (JCV) and is difficult to diagnose. We report on a male HIV-positive patient with PML finally diagnosed by 3 times lumbar punctures and 2 times brain biopsies. Negative results of JCV-PCR in cerebrospinal fluid (CSF) do not rule out the diagnosis of PML when clinical manifestations and neuroimaging features suspected PML. It is necessary to obtain new CSF and make repeat tests and even perform brain biopsy.

Berger JR, Aksamit AJ, Clifford DB, Davis L, Koralnik IJ, Sejvar JJ, Bartt R, Major EO, Nath A (2013) PML diagnostic criteria: consensus statement from the AAN Neuroinfectious Disease Section. Neurology 80:1430–1438. https://doi.org/10.1212/WNL.0b013e31828c2fa1CrossRefPubMedPubMedCentral

Bowen LN, Smith B, Reich D, Quezado M, Nath A (2016) HIV-associated opportunistic CNS infections: pathophysiology, diagnosis and treatment. Nat Rev Neurol 12:662–674. https://doi.org/10.1038/nrneurol.2016.149CrossRefPubMed

Cinque P, Koralnik IJ, Gerevini S, Miro JM, Price RW (2009) Progressive multifocal leukoencephalopathy in HIV-1 infection. Lancet Infect Dis 9:625–636. https://doi.org/10.1016/s1473-3099(09)70226-9CrossRefPubMedPubMedCentral

Falco V, Olmo M, del Saz SV, Guelar A, Santos JR, Gutierrez M, Colomer D, Deig E, Mateo G, Montero M, Pedrol E, Podzamczer D, Domingo P, Llibre JM (2008) Influence of HAART on the clinical course of HIV-1-infected patients with progressive multifocal leukoencephalopathy: results of an observational multicenter study. J Acquir Immune Defic Syndr 49:26–31. https://doi.org/10.1097/QAI.0b013e31817bec64CrossRefPubMed

Fournier A, Martin-Blondel G, Lechapt-Zalcman E, Dina J, Kazemi A, Verdon R, Mortier E, de La Blanchardiere A (2017) Immune reconstitution inflammatory syndrome unmasking or worsening AIDS-related progressive multifocal leukoencephalopathy: a literature review. Front Immunol 8:577. https://doi.org/10.3389/fimmu.2017.00577CrossRefPubMedPubMedCentral

Marzocchetti A, Di Giambenedetto S, Cingolani A, Ammassari A, Cauda R, De Luca A (2005) Reduced rate of diagnostic positive detection of JC virus DNA in cerebrospinal fluid in cases of suspected progressive multifocal leukoencephalopathy in the era of potent antiretroviral therapy. J Clin Microbiol 43:4175–4177. https://doi.org/10.1128/jcm.43.8.4175-4177.2005CrossRefPubMedPubMedCentral

McGuire D, Barhite S, Hollander H, Miles M (1995) JC virus DNA in cerebrospinal fluid of human immunodeficiency virus-infected patients: predictive value for progressive multifocal leukoencephalopathy. Ann Neurol 37:395–399. https://doi.org/10.1002/ana.410370316CrossRefPubMed

Nakamichi K, Kawamoto M, Ishii J, Saijo M (2019) Improving detection of JC virus by ultrafiltration of cerebrospinal fluid before polymerase chain reaction for the diagnosis of progressive multifocal leukoencephalopathy. BMC Neurol 19:252. https://doi.org/10.1186/s12883-019-1476-2CrossRefPubMedPubMedCentral

Weber T, Turner RW, Frye S, Luke W, Kretzschmar HA, Luer W, Hunsmann G (1994) Progressive multifocal leukoencephalopathy diagnosed by amplification of JC virus-specific DNA from cerebrospinal fluid. AIDS 8:49–57. https://doi.org/10.1097/00002030-199401000-00008CrossRefPubMed

Williamson EML, Berger JR (2017) Diagnosis and treatment of progressive multifocal leukoencephalopathy associated with multiple sclerosis therapies. Neurotherapeutics 14:961–973. https://doi.org/10.1007/s13311-017-0570-7CrossRefPubMedPubMedCentral

Zhai S, Brew BJ (2018) Progressive multifocal leukoencephalopathy. Handb Clin Neurol 152:123–137. https://doi.org/10.1016/b978-0-444-63849-6.00010-4CrossRefPubMed

Title: Progressive multifocal leukoencephalopathy in an HIV patient was diagnosed by 3 times lumbar punctures and 2 times brain biopsies
Authors: Mengyan Wang
Zhongdong Zhang
Jinchuan Shi
Hong Liu
Binhai Zhang
Jun Yan
Publication date: 01-12-2020
Publisher: Springer International Publishing
Keywords: Toxoplasmosis
Demyelinating Disease
Human Immunodeficiency Virus
Published in: Journal of NeuroVirology / Issue 6/2020
Print ISSN: 1355-0284
Electronic ISSN: 1538-2443
DOI: https://doi.org/10.1007/s13365-020-00893-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Progressive multifocal leukoencephalopathy in an HIV patient was diagnosed by 3 times lumbar punctures and 2 times brain biopsies

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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