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- Title
The "milky way" galaxy of HIV-related central nervous system immune reaction syndromes.
- Authors
Trunfio, Mattia; Manini, Claudia; Trentalange, Alice; Boghi, Andrea; Audagnotto, Sabrina; Imperiale, Daniele; Taraglio, Stefano; Bonora, Stefano; Di Perri, Giovanni; Calcagno, Andrea
- Abstract
The landscape of central nervous system HIV infection is rapidly changing, leading to the recognition of a new constellation of overlapping syndromes and to a better insight for the elder ones. Among these, progressive multifocal leukoencephalopathy (PML) still poses several diagnostic and therapeutic challenges; nevertheless, recent developments in understanding PML in patients with multiple sclerosis may have benefitted HIV-positive patients suffering from PML too. We describe a peculiar case of PML–immune reconstitution inflammatory syndrome (IRIS) presenting a punctate pattern with "milky way" appearance on magnetic resonance imaging. Despite the fact that brain imaging and histopathology remain the mainstays for extricating through the expanding galaxy of HIV-related central nervous system dysimmune syndromes and although punctate pattern has been already well acknowledged as a suggestive finding of PML among patients on natalizumab, this radiological presentation is still poorly recognised in AIDS-related PML cases, leading to possible life-threatening diagnostic delays. This is also the first report about intravenous immunoglobulin treatment in AIDS-related PML-IRIS; the favourable clinical and radiological outcome of our case and the preliminary administrations of intravenous immunoglobulins in natalizumab-associated PML-IRIS from literature support probable benefits also among HIV-positive patients.
- Subjects
NATALIZUMAB; CENTRAL nervous system; MILKY Way; CENTRAL nervous system infections; PROGRESSIVE multifocal leukoencephalopathy; IMMUNE reconstitution inflammatory syndrome
- Publication
Journal of NeuroVirology, 2019, Vol 25, Issue 6, p887
- ISSN
1355-0284
- Publication type
Article
- DOI
10.1007/s13365-019-00769-4