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

Abstract

We report here a case of a 37-year-old man with human immunodeficiency virus (HIV) infection followed by JC virus (JCV) infection and primary central nervous system lymphoma (PCNSL). The patient had been infected with HIV type 1 due to blood products for hemophilia A during infancy. He had progression of nervous symptoms and was diagnosed with progressive multifocal leukoencephalopathy (PML) clinically at the age of 36, when his CD4-positive lymphocyte counts ranged between 350 and 450/µl. Oral mefloquine, intravenous methylprednisolone pulse therapy, and intravenous immunoglobulin were not effective for the PML, and the patient entered a vegetative state. Brain biopsy revealed JCV infection without pathological findings of PML. Eight months after the clinical diagnosis of PML, he developed respiratory failure and brain magnetic resonance imaging revealed a mass lesion in the brain stem. The patient died 19 months after the diagnosis of PML. Autopsy findings were compatible with PCNSL. EBV-encoded small RNA-1-positive cells were not detected. We present a case of JCV-positive PCNSL with HIV infection complicated with clinical PML. 〔J Clin Exp Hematop 54(3) : 211-217, 2014〕

Neuroradiological features of lymphomatosis cerebri: A systematic review of the English literature with a new case report

“…A slight mass effect could have been caused by abnormal T2 hyperintensities, and consisted of mild compression of the adjacent ventricle or cistern in 18 cases (including the present case) ( 17 , 18 , 20 , 22 , 23 , 28 , 30 – 33 , 40 , 41 , 44 – 48 ) or mild sulcal effacement in 5 cases ( 21 , 36 , 40 , 41 , 49 ).…”

“…The lesions involved the corpus callosum in 19 cases (42.2%), the basal ganglia in 15 cases (33.3%), the thalamus in 12 cases (26.7%), the midbrain in 21 cases (46.7%), the pons in 20 cases (44.5%), the medulla in 14 cases (31.1%), the cerebellum in 12 cases (26.6%) and the spinal cord in 5 cases (11.1%) ( Table II ). Lesions were also observed in the cerebral ( 20 , 28 , 41 , 43 , 50 ) and cerebellar ( 35 , 41 ) cortices, and the cerebellar dentate nuclei ( 30 ).…”

The Use of Antimalarial Drugs against Viral Infection

“…In one case, MQ was administered with the antiviral cidofovir, resulting in final remission of the pathology, most likely due to synergy with other factors [121]. Different case reports have described the use of MQ by itself in HIV-positive PML patients, sometimes with repression of JCPyV replication [122][123][124][125] and rarely with the death of the patient [126]. The combined treatment MQ and mirtazapine was administered to HIV-positive patients, leading to a failure because of premature death and not always due to the PML itself [127,128].…”

“…Herpesviridae HCMV Artesunate [12,13,[46][47][48] Artesunate-amodiaquine [49] Arthemeter-lumefantrine [64] HHV6 Artesunate [52] Polyomaviridae JCPyV Artesunate [54,55] Mefloquine [72][73][74][75][76][77][78][79][80][81][82][83][84][85][86][87][88][122][123][124][125][126] Mefloquine and mirtazapine [86,87,127,128] Mefloquine, mirtazapine and a third drug [118,119] Mefloquine and risperidone [75] Mefloquine, risperidone and cytarabine [120] Mefloquine and cidofovir [121] Mefloquine and PML standard of care [129] Filoviridae EBOV Artesunate-amodiaquine [58,60] Nevertheless, some drugs have already been used in several clinical trials, as summarized in Table 1. Most of them regard the use of antimalarial drugs against HIV infection, but some of them failed, and...…”

Human polyomaviruses and cancer: an overview

“…Viral reactivation may lead to the development of PML, a fatal demyelinating disorder of the central nervous system caused by the destruction of oligodendrocytes as a consequence of the lytic viral cycle 11 , 140 . In addition, this virus has been associated with renal diseases in immunosuppressed individuals and organ transplant recipients 141 - 144 .…”