Focal Monophasic Demyelinating Leukoencephalopathy in Advanced HIV Infection

Abstract

A multiple sclerosis (MS)-like illness has been reported in human immunodeficiency virus (HIV)-infected patients, usually in the early stages of HIV infection. We report 3 patients with advanced HIV infection (CD4 lymphocyte count under 200/mm³) presenting with monophasic focal leukoencephalopathy, in whom biopsy demonstrated demyelinating lesions compatible with acute MS lesions. In 1 patient, recently started on highly active antiretroviral therapy, MS-like disease could represent an immune reconstitution syndrome. The lesions were reversible in 2 patients, but rapidly fatal in the third patient. These cases show that an MS-like disease may present in advanced HIV infection as focal monophasic leukoencephalopathy with either a reversible or fulminating course, mimicking progressive multifocal leukoencephalopathy.

Neurologic Complications of HIV-1 Infection and Its Treatment in the Era of Antiretroviral Therapy

“…22 Other CNS Syndromes Associated With HIV Infection In some patients with HIV infection, the viral infection presents with a multiple sclerosisYlike syndrome with either a relapsing-remitting or a progressive, fulminant course, correlating with leukoencephalopathy on MRI. 23 Pathology in these patients is consistent with demyelination but without identification of JC virus or the pathologic changes characteristic of progressive multifocal leukoencephalopathy (PML). A syndrome of fulminant encephalopathy, frequently accompanied by renal failure and seizures, has been identified in HIV-infected patients using IV drugs (Case 4-2).…”

Demyelinating diseases

“…In addition, patients with AIDS receiving highly active antiretroviral treatment may occasionally develop severe inflammatory demyelination that is not due to PML. [38][39][40] There is an intense perivascular inflammatory infiltrate of lymphocytes and macrophages. At least occasional macrophages (many, in some reported cases) are immunopositive for HIV.…”

Common Transcriptional Signatures in Brain Tissue from Patients with HIV-Associated Neurocognitive Disorders, Alzheimer’s Disease, and Multiple Sclerosis

“…For example, in some patients HIV infection was shown to correlate with the presence of leukoencephalomyelopathy and MS-like illness (Berger et al 1992; Corral et al 2004). In a recent cross-sectional cohort study, HAND was shown to correlate with presence of auto-antibodies to myelin oligodendrocyte glycoprotein, including in patients on ART with suppressed plasma HIV (Lackner et al 2010), suggesting that HAND and MS neuropathogenesis may overlap in the pathway of aberrant myelin breakdown.…”