Progressive multifocal leukoencephalopathy secondary to immune reconstitution syndrome
Progressive Multifocal Leukoencephalopathy (PML) represents an opportunistic infection of the central nervous system caused by the JC virus. This entity can appear in various pathologies in immunosuppressed hosts, mainly in patients with HIV / AIDS, however, up to 3% of cases can occur in immunocompetent people. In cases where the disease occurs in immunosuppressed patients, it may be due to two circumstances; the first, to the absence of treatment for the primary pathology, in this case HIV, and the second, as part of an immune reconstitution syndrome (IRS) after the initiation of antiretroviral therapy. The fundamental importance between these two circumstances is the treatment. While antiretroviral-free patients benefit from the initiation of these drugs, SRI patients benefit from the use of corticosteroids. The definitive PML diagnosis is histopathological, where the triad of demyelination, atypical astrocytes, and nuclear inclusion bodies in oligodendrocytes is classically presented.
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