scholarly journals Progressive multifocal leukoencephalopathy in an HIV patient was diagnosed by 3 times lumbar punctures and 2 times brain biopsies

2020 ◽  
Vol 26 (6) ◽  
pp. 952-956
Author(s):  
Mengyan Wang ◽  
Zhongdong Zhang ◽  
Jinchuan Shi ◽  
Hong Liu ◽  
Binhai Zhang ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Progressive Multifocal Leukoencephalopathy ◽  
Demyelinating Disease ◽  
Jc Virus ◽  
Clinical Manifestations ◽  
Brain Biopsy ◽  
Hiv Positive ◽  
Negative Results ◽  
The Central Nervous System ◽  
Rule Out

AbstractProgressive 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.

scholarly journals Neurobrucellosis mimicking primary vasculitis of the central nervous system: we should perform a metagenomic analysis of the cerebrospinal fluid prior to brain biopsy

2021 ◽  
Author(s):  
Marina Barrionuevo Mathias ◽  
Fernando Gatti ◽  
Gustavo Bruniera ◽  
Vitor Paes ◽  
Gisele Sampaio Silva ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Psychiatric Symptoms ◽  
Brain Mri ◽  
Genetic Material ◽  
Clinical Manifestations ◽  
Brain Biopsy ◽  
Metagenomic Analysis ◽  
Normal Brain ◽  
The Central Nervous System

Context Primary angiitis of the central nervous system (PACNS) is characterized by the inflammation of small and medium CNS arteries; the clinical manifestations include headache, cognitive impairment and focal neurological deficits. The gold standard test for diagnosis is brain biopsy. Neurobrucellosis is an infection associated with cattle farming, which leads to neurological and psychiatric symptoms. We report a case of neurobrucellosis mimicking PACNS. Case report Male, 32 years old, with fever, headache, dizziness and cognitive impairments for 30 days. History of stroke 2 years before, with mild sequelae right hemiparesis; investigation showed suspected intracranial dissection. On physical examination, he had apathy, preserved strength, reduced reflexes with plantar flexor responses. General laboratory tests, autoantibodies and serology were normal. Brain MRI showed deep left nucleocapsular gliosis and cerebral angiography revealed stenosis of the ICA and MCA. CSF showed 42 cells/ mm³, glucose 46 mg/dL, protein 82 mg/dL. Blood PCR was negative for Brucella. Immunophenotyping of the CSF and PET-CT excluded neoplasia. Brain biopsy was inconclusive for vasculitis. Metagenomic analysis of the CSF detected 78% of Brucella genetic material. Serum agglutination test was 1:40 for brucella. Conclusions PACNS is diagnosed by exclusion. The patient filled criteria for possible PACNS, image compatible with vascular stenosis, but inconclusive brain biopsy. Brucellosis is an endemic disease in underdeveloped countries that can present as CNS vasculitis. Metagenomic analysis allows the detection of different pathogens using a single method. The case illustrates the use of metagenomics in rare diseases characterized by vasculitis, with change in clinical outcomes and conduct.

scholarly journals Primary Angiitis of the Central Nervous System: A Report of Three Cases from a Single Colombian Center

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Nicolás Coronel-Restrepo ◽  
Fabio Bonilla-Abadía ◽  
Omar A. Cortes ◽  
Jorge H. Izquierdo ◽  
Alberto M. Shinchi ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Case Reports ◽  
Clinical Manifestations ◽  
Brain Biopsy ◽  
System A ◽  
Primary Angiitis ◽  
The Central Nervous System ◽  
Systemic Manifestations ◽  
Low Incidence

The primary angiitis of the central nervous system (PACNS) is an entity with a very low incidence and prevalence. It is not clear why the inflammatory process of this entity is limited to the cerebral vasculature without systemic manifestations. Its clinical manifestations are very heterogeneous and make clinical diagnosis difficult. In most cases, a brain biopsy is required. Only the clinical suspicion and the ability to recognize the possible clinical and imagenological patterns of presentation make an accurate diagnosis possible. The vast majority of the treatment recommendations are given by series of case reports. The following paper described the clinical, imagenological, and histopathological characteristics of three Colombian patients with PACNS. The strategic therapeutic used in shown.

scholarly journals Progressive Multifocal Leukoencephalopathy (PML) – a Case Report.

Pulse ◽  
2014 ◽  
Vol 6 (1-2) ◽  
pp. 57-59
Author(s):  
BS Khan ◽  
J Alam
Keyword(s):  
Immune Deficiency ◽  
Central Nervous System ◽  
Progressive Multifocal Leukoencephalopathy ◽  
Demyelinating Disease ◽  
Clinical Status ◽  
White Matter Lesions ◽  
Mass Effect ◽  
Viral Disease ◽  
Review Of Literature ◽  
The Central Nervous System

Progressive Multifocal Leukoencephalopathy (PML) is a rare and usually fatal viral disease occurring almost exclusively in people with severe immune deficiency. This is a demyelinating disease of the central nervous system (CNS) that usually leads to death or severe disability. Patients usually present with focal CNS abnormalities like; hemiparesis, apathy, and confusion. Multifocal white matter lesions without mass effect lead to the diagnosis of PML. In this article we present a review of literature and report of a case of PML in which the patient’s clinical status and MR findings are typical. DOI: http://dx.doi.org/10.3329/pulse.v6i1-2.20355 Pulse Vol.6 January-December 2013 p.57-59

scholarly journals PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY ASSOCIATED TO MULTIPLE SCLEROSIS THERAPIES: REVIEW OF THE LITERATURE

2015 ◽  
Vol 14 (4) ◽  
pp. 205-213
Author(s):  
Ana-Maria Vladila ◽  
◽  
Dan-Andrei Mitrea ◽  
Sanda Maria Nica ◽  
Ioan Buraga ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Central Nervous System ◽  
Nervous System ◽  
High Risk ◽  
Progressive Multifocal Leukoencephalopathy ◽  
Opportunistic Infection ◽  
Jc Virus ◽  
Review Of The Literature ◽  
Natalizumab Treatment ◽  
The Central Nervous System

Progressive multifocal leukoencephalopathy (PML) is an opportunistic infection associated with the reactivation of the JC virus, causing a severe demyelination within the central nervous system in patients with immunosuppression caused by disease or secondary to use of drugs. Several therapies used in the treatment of MS have reported cases of associated PML, most cases being related to Natalizumab treatment. In this article we review specific MS medication with a reported risk for PML, and also revise PML epidemiology, pathogenesis, treatment and available approaches on therapy in patients at high risk for developing this infection.

scholarly journals JC Virus Granule Cell Neuronopathy as AIDS-Presenting Illness

2018 ◽  
Vol 45 (4) ◽  
pp. 466-469 ◽  
Author(s):  
Simon Grandjean Lapierre ◽  
Xin Dang ◽  
Danielle Gilbert ◽  
Sylvie Lauzier ◽  
Igor J. Koralnik ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Virus Infection ◽  
Human Immunodeficiency Virus Infection ◽  
Progressive Multifocal Leukoencephalopathy ◽  
Granule Cell ◽  
Demyelinating Disease ◽  
Jc Virus ◽  
Clinical Manifestations ◽  
Immunodeficiency Virus ◽  
Granule Cell Neuronopathy

AbstractJC virus is the etiological agent of progressive multifocal leukoencephalopathy, a white matter demyelinating disease that mostly affects immunocompromised patients. JC virus can also infect neurons and meningeal cells and cause encephalitis, meningitis and granule cell neuronopathy. We report a patient with JC virus granule cell neuronopathy, without concomitant progressive multifocal leukoencephalopathy, presenting as inaugural acquired immune deficiency syndrome-related illness. This patient’s human immunodeficiency virus infection remained undiagnosed for several months after neurological symptoms onset. We review JC virus pathophysiology, clinical manifestations, treatment and prognosis, and emphasize the importance of considering human immunodeficiency virus infection and related opportunistic infections in the differential diagnosis of new-onset isolated cerebellar disease.

scholarly journals Does Mefloquine (Lariam®) Therapy Improve the Prognosis of Human JC Polyomavirus-Induced Progressive Multifocal Leukoencephalopathy?

2014 ◽  
Vol 7 (1) ◽  
pp. 3-7
Author(s):  
Zlatko N. Kalvatchev ◽  
Iliya T. Tsekov
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Progressive Multifocal Leukoencephalopathy ◽  
Jc Virus ◽  
Published Data ◽  
Jc Polyomavirus ◽  
The Central Nervous System ◽  
Good Penetration

Abstract Progressive multifocal leukoencephalopathy (PML) is ademyelinating disease caused by infection with Polyomavirus hominis 2, popularly known as JC virus (JCV). The disease is usually fatal as it develops due to the progressive destruction of oligodendrocytes in multiple brain foci. Several substances that show effect against JCV have been investigated. However, only the antimalarial drug mefloquine has been reported to significantly influence the viral replication both in vitro and following in vivo therapy with good penetration and distribution of the drug at efficacious concentrations into the central nervous system (CNS). The current material presents some of the available published data, suggesting that the activity of mefloquine against JCV be considered for treatment of patients with PML.

scholarly journals Replication of JC Virus DNA in the G144 Oligodendrocyte Cell Line Is Dependent Upon Akt

2017 ◽  
Vol 91 (20) ◽  
Author(s):  
Jesse N. Peterson ◽  
Brian Lin ◽  
Jong Shin ◽  
Paul J. Phelan ◽  
Philip Tsichlis ◽  
...  
Keyword(s):  
Dna Replication ◽  
Progressive Multifocal Leukoencephalopathy ◽  
Cell Line ◽  
Demyelinating Disease ◽  
Jc Virus ◽  
Specific Inhibitor ◽  
Human Cell Line ◽  
Model System ◽  
Precursor Cell Line ◽  
The Central Nervous System

ABSTRACT Progressive multifocal leukoencephalopathy (PML) is an often-fatal demyelinating disease of the central nervous system. PML results when oligodendrocytes within immunocompromised individuals are infected with the human JC virus (JCV). We have identified an oligodendrocyte precursor cell line, termed G144, that supports robust levels of JCV DNA replication, a central part of the JCV life cycle. In addition, we have determined that JC virus readily infects G144 cells. Furthermore, we have determined that JCV DNA replication in G144 cells is stimulated by myristoylated (i.e., constitutively active) Akt and reduced by the Akt-specific inhibitor MK2206. Thus, this oligodendrocyte-based model system will be useful for a number of purposes, such as studies of JCV infection, establishing key pathways needed for the regulation of JCV DNA replication, and identifying inhibitors of this process. IMPORTANCE The disease progressive multifocal leukoencephalopathy (PML) is caused by the infection of particular brain cells, termed oligodendrocytes, by the JC virus. Studies of PML, however, have been hampered by the lack of an immortalized human cell line derived from oligodendrocytes. Here, we report that the G144 oligodendrocyte cell line supports both infection by JC virus and robust levels of JCV DNA replication. Moreover, we have established that the Akt pathway regulates JCV DNA replication and that JCV DNA replication can be inhibited by MK2206, a compound that is specific for Akt. These and related findings suggest that we have established a powerful oligodendrocyte-based model system for studies of JCV-dependent PML.

scholarly journals JC Polyomavirus (JCV) and Monoclonal Antibodies: Friends or Potential Foes?

2013 ◽  
Vol 2013 ◽  
pp. 1-11 ◽  
Author(s):  
Roberta Antonia Diotti ◽  
Akira Nakanishi ◽  
Nicola Clementi ◽  
Nicasio Mancini ◽  
Elena Criscuolo ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Central Nervous System ◽  
Nervous System ◽  
Monoclonal Antibodies ◽  
Demyelinating Disease ◽  
Jc Virus ◽  
Jc Polyomavirus ◽  
High Incidence ◽  
Two Factors ◽  
The Central Nervous System

Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system (CNS), observed in immunodeficient patients and caused by JC virus ((JCV), also called JC polyomavirus (JCPyV)). After the HIV pandemic and the introduction of immunomodulatory therapy, the PML incidence significantly increased. The correlation between the use of natalizumab, a drug used in multiple sclerosis (MS), and the PML development of particular relevance. The high incidence of PML in natalizumab-treated patients has highlighted the importance of two factors: the need of PML risk stratification among natalizumab-treated patients and the need of effective therapeutic options. In this review, we discuss these two needs under the light of the major viral models of PML etiopathogenesis.

scholarly journals Clinical signs of tuberculosis relapses in HIV patients

2020 ◽  
Vol 98 (6) ◽  
pp. 32-35
Author(s):  
E. Yu. Zorkаltsevа ◽  
Yu. O. Egorovа
Keyword(s):  
Central Nervous System ◽  
Hiv Infection ◽  
Treatment Efficacy ◽  
Medical Records ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Hiv Positive ◽  
Hiv Patients ◽  
The Central Nervous System ◽  
Hiv Negative

The objective: to study clinical manifestations of tuberculosis relapses and their treatment outcomes in patients with HIV infection.Subjects and Methods. 132 medical records of patients with tuberculosis relapses were analyzed; 69 of them were HIV-positive and 63 were HIV-negative. All of them were admitted to Irkutsk Regional Clinical Tuberculosis Hospital from 2016 to 2019, and then continued treatment of tuberculosis on the out-patient basis. Treatment efficacy was assessed in February 2020.Results. More severe clinical forms of tuberculosis relapses were typical of HIV patients including generalized forms affecting the central nervous system. Therefore, among these patients, the mortality rate is significantly higher (24.6%) than in tuberculosis relapses with no concurrent HIV infection (6.3%), p ≤ 0.05.

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