Inflammatory progressive multifocal leukoencephalopathy in human immunodeficiency virus-negative patients.
OBJECTIVE
Inflammatory progressive multifocal leukoencephalopathy (iPML) with enhancing magnetic resonance imaging (MRI) lesions and leukocyte infiltration occurs in human immunodeficiency virus (HIV)-infected individuals after highly active antiretroviral therapy (HAART) treatment. MRI diagnostic criteria for PML suggest that iPML does not occur in HIV-negative individuals.


METHODS
We studied pathologically proved PML (12 by biopsy, 9 with MRI, 32 at autopsy).


RESULTS
HIV-negative (2/5) and -positive (2/4) PML patients had enhancing MRI lesions, correlated with CD3(+) lymphocyte infiltration. Inflammatory infiltrates occurred in the majority of HIV-negative (7/8) and HIV-positive/HAART (17/20) cases (p > 0.2), but in only 2 of 16 HIV-positive/non-HAART cases (p < 0.001).


CONCLUSIONS
iPML showed radiographic and pathological similarity in HIV-positive/HAART and HIV-negative patients. HIV-negative iPML necessitates further consideration of MRI criteria for PML.
Huang
DeRen
D
Department of Neurology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA. huangd2@ccf.org
Cossoy
Michael
M
Li
Meizhang
M
Choi
Dean
D
Taege
Alan
A
Staugaitis
Susan M
SM
Rehm
Susan
S
Ransohoff
Richard M
RM
D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D001706:Biopsy; D001921:Brain / Q000473:pathology / Q000821:virology; D018791:CD4 Lymphocyte Count; D016009:Chi-Square Distribution; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000188:drug therapy / Q000473:pathology*; D006801:Humans; D007968:Leukoencephalopathy, Progressive Multifocal / Q000209:etiology* / Q000276:immunology / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged