Progressive multifocal leukoencephalopathy as an AIDS-defining condition in a patient with high CD4+ T-lymphocyte count

Abstract

We present the case of a 31-year-old man with acute manifestation of progressive multifocal leukoencephalopathy (PML) as an AIDS-defining disease. The patient presented with a three-day history of neurological disease, brain lesions without mass effect or contrast uptake and a slightly increased protein concentration in cerebrospinal fluid. A serological test for HIV was positive and the CD4+ T-cell count was 427/mm³. Histological examination of the brain tissue revealed abnormalities compatible with PML. The disease progressed despite antiretroviral therapy, and the patient died three months later. PML remains an important cause of morbidity and mortality among HIV-infected patients.

Progressive Multifocal Leukoencephalopathy as the First Manifestation of AIDS: A Rare Case Report

“…The patient examined in this study also began combined ART; however, her symptoms progressed. In summary, PML results from brain infection with JCV and it is usually rapidly fatal in cases of HIV infection (12). Our case died like other cases.…”

“…We found five case-reports of AID-related PML. Most cases diagnosed with this disease are male and only one case was treated (Table 1) (7,(9)(10)(11)(12). The diagnosis of PML is based on three stages: clinical suspicion, radiological identification, and etiological confirmation by CSF or tissue analysis (9,12).…”

“…Most cases diagnosed with this disease are male and only one case was treated (Table 1) (7,(9)(10)(11)(12). The diagnosis of PML is based on three stages: clinical suspicion, radiological identification, and etiological confirmation by CSF or tissue analysis (9,12). This patient was diagnosed with PML by clinical presentation, PCR for the JC virus in CSF, and brain MRI.…”

Development of Primary Central Nervous System Lymphoma Associated with Human Immunodeficiency Virus and JC Virus Infection

“…4 However, PML may also develop in patients with blood CD4-positive T-cell counts of no less than 200 cells/mL after the initiating ART, or in those without previous immunomodulatory drugs or immunosuppression, while the latter would be the case much more rarely. [5][6][7] Hence, the relatively high number of CD4-positive T cells in the present case does not rule out the diagnosis of PML. Secondly, the absence of JCV in CSF and the lack of glial reaction in the tissue of brain biopsy in the present case could be misleading.…”

“…His previous medical history included hemophilia A and HIV-1 infection through blood product transfusions in infancy. Anti-retroviral therapy (ART) was started in 1993, 1) Hematology, 3) Neurology, 4) Neurosurgery, and 5) Laboratory Medicine, NHO Matsumoto Medical Center, Matsumoto, Japan 2) Division of Hematology, Department of Internal Medicine, 6) but his HIV-1 viral load (VL) had been high because of poor adherence to the prescription and leukocytopenia had been remarkable, with the number of CD4-positive lymphocytes ranging between 200 and 400 × 10 6 /L. The results of repeated tests for drug resistance to HIV-1 were negative.…”