You are viewing the site in preview mode

Skip to content

Advertisement

  • Poster presentation
  • Open Access

PML-not a surprise in four young HIV infected patients

  • 1,
  • 2,
  • 2,
  • 2,
  • 2,
  • 2,
  • 1 and
  • 2
BMC Infectious Diseases201414 (Suppl 4) :P34

https://doi.org/10.1186/1471-2334-14-S4-P34

  • Published:

Keywords

  • Progressive Multifocal Leukoencephalopathy
  • Progressive Multifocal Leukoencephalopathy
  • Good Penetration
  • Focal Neurological Sign
  • Case Progressive Multifocal Leukoencephalopathy

An important cause of mortality in patients from Romanian cohort remains progressive multifocal leukoencephalopathy (PML) caused by the polyomavirus, JC virus (JCV).

PML is an opportunistic infection and one of the AIDS-defining conditions in HIV-infected patients and is associated with both HIV-1 and HIV-2.

We perform a retrospective study in which we included 4 patients from Cluj-Napoca HIV Center. These patients belong to Romanian cohort and were with poor adherence to treatment.

We collected information on clinical and immunological status, microbiologic and virological analysis, neuroimaging, treatment and outcome.

From 4 patients with a median age of 20.75 years at the moment of PML diagnosis, 3 were male and 1 was a female, 3 died and 1 is alive.

All patients were already in stage AIDS C3 at the moment of PML diagnosis and with a CD4 lymphocytes level below 20 cells/cmm.

The onset was insidious in all cases with focal neurological signs (hemiparesis, facial palsy, dysarthria and mental alteration) without fever.

In two cases we performed lumbar puncture that revealed clear CSF, with normal level of glucose and proteins, negative Gram stain and negative culture but with JC virus load positive (RT-PCR JCV from CSF).

The imagistic methods (cerebral MRI) showed in all cases lesions localized in white matter, without mass effect from these lesions. For two cases we completed examination with cerebral MR spectroscopy which revealed spectroscopic disorders specific for PML.

In all cases we excluded other etiologies by serological, bacteriological and imagistic tests.

All patients received cART with good penetration in CSF and corticotherapy, but in 3 cases neurologic disorders evolved to tetraparesis, aphasia and profound altered mental status and finally death.

1 patient had a good neurologic recovery and remains with easy ataxia and dysarthria.

In these cases PML is a result of low adherence to treatment of patients from Romanian cohort and opportunistic infection was not a surprise. The most important differential diagnosis was HIV encephalopathy.

We can conclude that our patients with PML had a poor prognosis despite intensive cART with good penetration in CSF.

Authors’ Affiliations

(1)
Infectious Disease Department, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
(2)
Infectious Diseased Clinic, Cluj-Napoca, Romania

Copyright

© Cioară et al; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Advertisement