Progressive multifocal leukoencephalopathy in an HIV patient was diagnosed by 3 times lumbar punctures and 2 times brain
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CASE REPORT
Progressive multifocal leukoencephalopathy in an HIV patient was diagnosed by 3 times lumbar punctures and 2 times brain biopsies Mengyan Wang 1 & Zhongdong Zhang 1 & Jinchuan Shi 1 & Hong Liu 1 & Binhai Zhang 1 & Jun Yan 1 Received: 31 January 2020 / Revised: 28 July 2020 / Accepted: 14 August 2020 # The Author(s) 2020
Abstract Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating disease of the central nervous system caused by JC virus (JCV) and is difficult to diagnose. We report on a male HIV-positive patient with PML finally diagnosed by 3 times lumbar punctures and 2 times brain biopsies. Negative results of JCV-PCR in cerebrospinal fluid (CSF) do not rule out the diagnosis of PML when clinical manifestations and neuroimaging features suspected PML. It is necessary to obtain new CSF and make repeat tests and even perform brain biopsy. Keywords Progressive multifocal leukoencephalopathy . HIV . JC virus
Introduction In HIV-positive individuals, central nervous system (CNS) infections remain a major cause of morbidity and mortality. And cerebral toxoplasmosis, progressive multifocal leukoencephalopathy (PML), tuberculous meningitis, cryptococcal meningitis, and cytomegalovirus infection are the common CNS opportunistic infections in HIV-positive individuals (Bowen et al. 2016). PML is a kind of demyelinating disease of the CNS caused by JC virus (JCV). In recent years, with the prevalence of AIDS and the widespread use of monoclonal antibodies, the incidence of PML has increased. Currently,
* Jun Yan [email protected] Mengyan Wang [email protected] Zhongdong Zhang [email protected] Jinchuan Shi [email protected] Hong Liu [email protected] Binhai Zhang [email protected] 1
Xixi Hospital of Hangzhou, Hangzhou 310023, China
HIV infection accounts for approximately 80% of new PML cases (Fournier et al. 2017). Herein, we report a case of PML detected by 3 times lumbar punctures and 2 times brain biopsies in an HIV-infected patient.
Case presentation A 47-year-old man with 15 years history of HIV infection had not received combined antiretroviral therapy (cART) before. One month ago, the patient started to have a skewed mouth with unclear speech, and after 2 weeks, the patient developed left limb movement disorder, gradually progressed to hemiplegia, and was referred to our hospital. Physical examination demonstrated that the patient’s left nasolabial sulcus became shallow, the corner of the mouth was skewed, the left limb muscle strength was 0, the muscle tone was normal, the sensation of shallow and deep was diminished, the left Babinski sign was positive manifested as hallux dorsiflexion, and the remaining four toes were fanned out. On blood examination, CD4 was 48/μL, and viral load was 11,800 IU/mL. There is no sign of bacterial, mycobacterium, and fungal infection. MRI of the brain showed massive necrosis of the right frontal parietal occipital lobe and left frontaltemporal lobe. Lacunar ischemia was scattered on both sides of the ventricle (Fig. 1). CSF analysis were wi
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