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Immune Reconstitution Inflammatory Syndrome with Recurrent Paradoxical Cerebellar HIV-Associated Progressive Multifocal Leukoencephalopathy.
Pathogens
June 2021
Jackson Memorial Hospital, 1611 NW 12th Ave, Miami, FL 33136, USA.
Progressive multifocal leukoencephalopathy (PML), presenting as immune reconstitution inflammatory syndrome (IRIS), is a known complication of antiretroviral therapy (ART) in people living with HIV (PLWH). Typically preceded by ART initiation, IRIS may appear simultaneously/unmasked (PML-s-IRIS) or as a delayed/worsening/paradoxical (PML-d-IRIS) presentation of known PML disease. Primary cerebellar tropism continues to be a rare presentation, and paradoxical cerebellar involvement of PML-IRIS syndrome can be a challenge for both diagnosis and management.
View Article and Find Full Text PDFIncidence and prognosis of immune reconstitution inflammatory syndrome in HIV-associated progressive multifocal leucoencephalopathy.
Eur J Neurol
May 2016
Department of Neurology, Hospital Universitario Ramón y Cajal, Madrid, Spain.
Background And Purpose: Progressive multifocal leucoencephalopathy-associated immune reconstitution inflammatory syndrome (PML-IRIS) is the paradoxical worsening or unmasking of preexisting infection with JC virus attributable to a rapid recovery of the immune system after highly active antiretroviral therapy (HAART) initiation. We investigated the incidence and factors associated with PML-IRIS in HIV-infected patients. We also studied its influence on mortality of PML and the effect of corticosteroid therapy.
View Article and Find Full Text PDFSimultaneous PML-IRIS and myelitis in a patient with neuromyelitis optica spectrum disorder.
Neurol Clin Pract
October 2013
Department of Neurology Mayo Clinic, Rochester, MN.
A case report of simultaneous PML-IRIS during corticosteroids tapering in a patient with an anti-synthetase syndrome.
F1000Res
April 2014
INSERM UMR 1043, Centre de Physiopathologie, Toulouse-Purpan, France ; Université Toulouse III, Toulouse F-31000, France ; Department of Neurology, Toulouse University Hospital, Toulouse, France.
We report a case of simultaneous progressive multifocal leukoencephalopathy-associated immune reconstitution inflammatory syndrome (PML-IRIS) during corticosteroid tapering in a patient with an anti-synthetase syndrome. We describe the challenges associated with the diagnosis and the management of this emerging inflammatory neurological condition in this immunocompromised patient with a severe rheumatic disease. We highlight that, in the setting of IRIS, the low-level of the JC virus viral load requires a sensitive PCR assay before excluding PML.
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