Korean J Med.  2010 Jun;78(6):771-775.

A report of seven cases of progressive multifocal leukoencephalopathy in patients with acquired immune deficiency syndrome

• Kwak DM
• Jeong H
• Park SM
• Cha HH
• Jung JY
• Bang JH
• Shin HS

Abstract

Secondary opportunistic central nervous system infections occur in approximately one-third of patients with acquired immune deficiency syndrome. With the introduction of highly active antiretroviral therapy, the number of opportunistic infection cases has significantly decreased. However, the number of progressive multifocal leukoencephalopathy (PML) cases caused by opportunistic human JC polyomavirus has not decreased at a noticeable rate. In this report, seven patients with PML were evaluated at the infectious disease unit of the National Medical Center. Six of the 7 patients were not on antiretroviral therapy at the time of diagnosis. The mean patient age of the 6 men and 1 woman was 39 years. The individual CD4 cell counts were 58, 6, 18, 73, 90, 252, and 94 cells/microliter. The mean CD4 cell count was 84 cells/microliter. The most common clinical manifestation was focal weakness and the temporal lobe was mainly involved. Two of the patients died 52 days after the diagnosis was made. Three patients survived for more than 1 year without disease progression. We conclude that one must take a careful patient history, perform a neurological examination, and examine brain magnetic resonance images in patients with human immunodeficiency virus who show neurological symptoms.

Keyword

AIDS; HIV; JC virus; Progressive multifocal leukoencephalopathy

MeSH Terms

Acquired Immunodeficiency Syndrome
Antiretroviral Therapy, Highly Active
Brain
CD4 Lymphocyte Count
Central Nervous System Infections
Communicable Diseases
Disease Progression
Female
HIV
Humans
JC Virus
Leukoencephalopathy, Progressive Multifocal
Magnetic Resonance Spectroscopy
Male
Neurologic Examination
Opportunistic Infections
Temporal Lobe