Progressive multifocal leukoencephalopathy in AIDS: A report on 15 cases

Original article


Rayes AA 1, Ben Khalil IM 2

1-Faculty of Medicine, Al Fateh University for Medical Sciences, and Infectious Diseases Department, Tripoli Medical Center, Libya. 2-Infectious Diseases Department, Tripoli Medical Center, Libya.

Libyan J Infect Dis. 2009;3(2):25-29


Background: Progressive Multifocal Leukoencephalopathy (PML) is a degenerative disease of the central nervous system (CNS) caused by JC virus. It usually affects HIV-infected patients with a CD4 count of less than 100cells/μL and carries a poor prognosis. Its clinical and radiological features are suggestive but could be similar to other diseases that can affect the CNS. Except for one report, PML has not been reported in the Libyan medical literature.
Objective: to report the clinical and radiological features of PML and its prognosis in 15 HIV-infected patients.
Methods: we examined 15 HIV-infected patients with PML attended at the Infectious Diseases Department (IDD) of Tripoli Medical Centre (TMC) between 2005 and 2008. Routine investigations, a CT-scan and/or MRI were also done.
Results: 15 patients were examined. All of them, except one, were males. Their ages ranged from 16 to 45 years (mean age: 34.7 year). Cognitive, motor and visual symptoms were found in 60%, 46% and 27% of the patients, respectively. Dysphasia was common affecting 30% of them. Focal and/or generalized fits were observed in 26% of the patients. Cerebellar symptoms/signs were found in four patients (27%), in two of them they were the only neurological symptoms. All the patients had typical MRI/CT scan findings of PML (hypo dense white matter in T1 weighted and hyperdense areas in T2 weighted MRI) without a mass effect.
Conclusions: PML is not uncommon CNS disease and should be considered in the differential diagnosis of CNS manifestations in patients with HIV infection.

Keywords: progressive multifocal leukoencephalopathy, HIV, AIDS, JC virus.