title: Diagnostic delay in progressive multifocal leukoencephalopathy.
abstract: We investigated delay in diagnosing progressive multifocal leukoencephalopathy (PML). The median time from initial symptom to diagnosis was 74 days (range 1-1643) in 111 PML patients seen at our institution from 1993 to 2015. Another diagnosis was considered before PML in nearly two-thirds, and more than three-quarters of patients suffered from diagnostic delay greater than 1 month, irrespective of their underlying immunosuppressive condition. Extended diagnostic delay occurred more frequently in patients with possible PML, and among HIV (+) patients with higher CD4(+) T-cell counts at symptom onset. Prompt diagnosis may improve survival of PML in so far as immune reconstitution can be effected, and prevent unnecessary interventions.
authors.affiliation: Division of Neuro-Immunology Departments of Neurology and Medicine Center for Virology and Vaccine Research Beth Israel Deaconess Medical Center Harvard Medical School Boston Massachusetts.
authors.forename: Dhanashri P
authors.initials: DP
authors.lastname: Miskin
authors.affiliation: Division of General Medicine and Primary Care Section for Research Department of Medicine Beth Israel Deaconess Medical Center Harvard Medical School Boston Massachusetts.
authors.forename: Long H
authors.initials: LH
authors.lastname: Ngo
authors.affiliation: Division of Neuro-Immunology Departments of Neurology and Medicine Center for Virology and Vaccine Research Beth Israel Deaconess Medical Center Harvard Medical School Boston Massachusetts.
authors.forename: Igor J
authors.initials: IJ
authors.lastname: Koralnik