Progressive multifocal leukoencephalopathy in an adolescent child infected with human immunodeficiency virus: a case report
DOI:
https://doi.org/10.18203/2349-3291.ijcp20232892Keywords:
Progressive multifocal leukoencephalopathy, Human immunodeficiency virus, Adolescence, Computerized tomography, Magnetic resonance imagingAbstract
Progressive multifocal leukoencephalopathy (PML) is an AIDS-defining neurologic disease caused by the JC polyoma virus. It typically occurs in immunocompromised individuals and without treatment, patients have a relentless downhill course. Early detection may improve the prognosis. A 12-year-old male child, a known HIV positive case with abdominal tuberculosis on ATT for 15 days, was brought to us in status epilepticus. After controlling seizures with phenytoin, the child was intubated and mechanically ventilated. Antiretroviral therapy (ART) was withheld temporarily and Anti-tuberculous therapy (ATT) was modified. Plain computerised tomography of the brain showed atrophy of brain parenchyma. Five days after the patient was shifted out of ICU, he again developed multiple episodes of convulsions. All reversible causes were investigated for and ruled out. MRI brain revealed features suggestive of PML with diffuse cerebral and cerebellar atrophy which was disproportionate to age. At present, the incidence of PML in children affected with HIV is still rare. There is still limited information regarding this spectrum of patients, especially their further management following diagnosis. Precise treatment protocols would help guide clinicians in regard to diagnosis and management of these complex cases.
References
Post MJ, Yiannoutsos C, Simpson D. Progressive multifocal leukoencephalopathy in AIDS: Are there any MR findings useful to patient management and predictive of patient survival? AIDS Clinical Trials Group, 234 Team. AJNR Am J Neuroradiol. 1999;20:1896-906.
Mader I, Herrlinger U, Klose U, Schmidt F, Ku¨ker W. Progressive multifocal leukoencephalopathy: analysis of lesion development with diffusion-weighted MRI. Neuroradiol. 2003;45:717-21.
Berger JR, Major EO. Progressive multifocal leukoencephalopathy. Semin Neurol. 1999;19:193-200.
Itoyama Y, Webster HD, Sternberger NH. Distribution of papovavirus, myelin-associated glycoprotein, and myelin-basic protein in progressive multifocal leukoencephalopathy lesions. Ann Neurol. 1982;11:396-407.
McGuire D, Barhite S, Hollander H, Miles M. JC virus DNA in cerebrospinal fluid of human immunodeficiency virus-infected patients: predictive value for progressive multifocal leukoencephalopathy. Ann Neurol. 1995;37:395-9.
Sugimoto C, Tanaka K, Matsuda H. Amplification of JC virus regulatory DNA sequences from cerebrospinal fluid: diagnostic value for progressive multifocal leukoencephalopathy. Arch Virol. 1998;143:249-62.
Chaisson RE, Griffin DE. Progressive multifocal leukoencephalopathy in AIDS. JAMA. 1990;264:79-82.
Padgett BL, Walker DL. Prevalence of antibodies in human sera against JC virus, an isolate from a case of progressive multifocal leukoencephalopathy. J Infect Dis. 1973;127(4):467-70.
Centers for Disease Control and Prevention. Treating opportunistic infections among HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association/Infectious Diseases Society of America. MMWR. 2004;53(15):45-46.
10. Von Einsiedel RW, Fife TD, Aksamit AJ, et al. Progressive multifocal leukoencephalopathy in AIDS: clinicopathologic study and review of the literature. J Neurol. 1993; 240: 391–406.
Morriss MC, Rutstein RM, Rudy B, Desrochers C, Hunter JV, Zimmerman RA. Progressive multifocal leukoencephalopathy in an HIV-infected child. Neuroradiology. 1997;39:142-4.
Brooks BR, Walker DL. Progressive multifocal leuko-encephalopathy. Neurol Clin. 1984;2:299-313.
Miller JR, Barnett RE, Brittoh CB. Progressive multifocal leukoencephalopathy in a male homosexual with T cell immune deficiency. N Engl J Med. 1982;12:1436.
Oberdorfer P, Washington CH, Katanyuwong K, Jittamala P. Progressive multifocal leukoencephalopathy in HIV-infected children: a case report and literature review. Int J Pediatr. 2009.
Whiteman MLH, Post MJD, Berger JR, Tate LG, Bell MD, Limonte LP. Progressive multifocal leukoencephalopathy in 47 HIV-seropositive patients: neuroimaging with clinical and pathologic correlation. Radiology. 1993;187(1):233-40.
Huisman TAGM, Boltshauser E, Martin E, Nadal D. Diffusion tensor imaging in progressive multifocal leukoencephalopathy: early predictor for demyelination? AJNR Am J Neuroradiol. 2005;26:2153-6.
Sze G, Brant-Zawadzki MN, Norman D, Newton TH. The neuroradiology of AIDS. Semin Roentgenol. 1987;22:42-53.
Marra CM, Rajicic N, Barker DE. for the Adult AIDS Clinical Trials Group 363 Team. A pilot study of cidofovir for progressive multifocal leukoencephalopathy in AIDS. AIDS. 2002;16:1791-7.
Lalezari JP, Holland GN, Kramer F. Randomized, controlled study of the safety and efficacy of intravenous cidofovir for the treatment of relapsing cytomegalovirus retinitis in patients with AIDS. J Acquir Immune Defic Syndr Hum Retrovirol. 1998;17:339-44.
