Progressive Multifocal Leukoencephalopathy in a Young Medication-Noncompliant HIV Patient: A Case Report and Literature Review

Overview

Journal Cureus

Date 2025 Feb 3

PMID 39897212

Authors

Nyan Lin Aung

Ruth Mamo

Gianna Castellano

Abrisham Akbariansaravi

Affiliations

Soon will be listed here.

Abstract

Progressive multifocal leukoencephalopathy (PML) is a rare and debilitating opportunistic infection of the central nervous system (CNS) caused by the John Cunningham (JC) virus. It predominantly affects immunocompromised individuals, including those with advanced HIV infection. The incidence of PML in people living with human immunodeficiency virus (HIV) has significantly declined in the era of antiretroviral therapy (ART). We report a case of PML in a young patient with a history of medication non-compliance, presenting with progressive neurological deficits, underscoring the importance of adherence to ART in preventing opportunistic infections.

References

Nshimiyimana J, Onsongo S . Progressive Multifocal Leukoencephalopathy confined to the posterior fossa as the presenting manifestation of HIV in a paediatric patient. IDCases. 2024; 37:e02064. PMC: 11388200. DOI: 10.1016/j.idcr.2024.e02064. View

Jiang R, Song Z, Liu L, Mei X, Sun J, Qi T . Survival and prognostic factors of progressive multifocal leukoencephalopathy in people living with HIV in modern ART era. Front Cell Infect Microbiol. 2023; 13:1208155. PMC: 10663249. DOI: 10.3389/fcimb.2023.1208155. View

Engsig F, Hansen A, Omland L, Kronborg G, Gerstoft J, Lund Laursen A . Incidence, clinical presentation, and outcome of progressive multifocal leukoencephalopathy in HIV-infected patients during the highly active antiretroviral therapy era: a nationwide cohort study. J Infect Dis. 2008; 199(1):77-83. DOI: 10.1086/595299. View

Tan C, Koralnik I . Progressive multifocal leukoencephalopathy and other disorders caused by JC virus: clinical features and pathogenesis. Lancet Neurol. 2010; 9(4):425-37. PMC: 2880524. DOI: 10.1016/S1474-4422(10)70040-5. View

Khalili A, Craigie M, Donadoni M, Sariyer I . Host-Immune Interactions in JC Virus Reactivation and Development of Progressive Multifocal Leukoencephalopathy (PML). J Neuroimmune Pharmacol. 2019; 14(4):649-660. PMC: 6898772. DOI: 10.1007/s11481-019-09877-8. View

Oberdorfer P, Washington C, Katanyuwong K, Jittamala P . Progressive Multifocal Leukoencephalopathy in HIV-Infected Children: A Case Report and Literature Review. Int J Pediatr. 2009; 2009:348507. PMC: 2778135. DOI: 10.1155/2009/348507. View

Adapa S, Jagdale N, Vutukuru K, Kondapalli M, Agarwal S . Atypical Presentation of a Patient With Progressive Multifocal Leukoencephalopathy. Cureus. 2024; 16(6):e62545. PMC: 11253582. DOI: 10.7759/cureus.62545. View

French M . Immune reconstitution inflammatory syndrome: immune restoration disease 20 years on. Med J Aust. 2012; 196(5):318-21. DOI: 10.5694/mja12.10089. View

Kudva G, Maliekel K, Richart J, Batanian J, Grosso L, Sokol-Anderson M . Acute promyelocytic leukemia and HIV-1 infection: case report and review of the literature. Am J Hematol. 2004; 77(3):287-90. DOI: 10.1002/ajh.20192. View

10.

Chang C . AIDS-related progressive multifocal leukoencephalopathy in a patient presenting with cerebellar ataxia. Rev Soc Bras Med Trop. 2021; 54:e02112021. PMC: 8186892. DOI: 10.1590/0037-8682-0211-2021. View

11.

Camila Cardenas M, Farnan S, Hamel B, Mejia Plazas M, Sintim-Aboagye E, Littlefield D . Prevention of the Vertical Transmission of HIV; A Recap of the Journey so Far. Viruses. 2023; 15(4). PMC: 10142818. DOI: 10.3390/v15040849. View

12.

Graf L, Rosenkranz S, Holzemer A, Hagel C, Goebell E, Jordan S . Clinical Presentation and Disease Course of 37 Consecutive Cases of Progressive Multifocal Leukoencephalopathy (PML) at a German Tertiary-Care Hospital: A Retrospective Observational Study. Front Neurol. 2021; 12:632535. PMC: 7890249. DOI: 10.3389/fneur.2021.632535. View

13.

Post M, Thurnher M, Clifford D, Nath A, Gonzalez R, Gupta R . CNS-immune reconstitution inflammatory syndrome in the setting of HIV infection, part 2: discussion of neuro-immune reconstitution inflammatory syndrome with and without other pathogens. AJNR Am J Neuroradiol. 2012; 34(7):1308-18. PMC: 4905746. DOI: 10.3174/ajnr.A3184. View