Progressive Multifocal Leukoencephalopathy with Balanced CD4/CD8 T-Cell Infiltration and Good Response to Mefloquine Treatment.
A 53-year-old man was admitted for sub-acute progressive dementia and Gerstmann syndrome. MRI demonstrated lesions in the white matter involving the left parietal lobe, accompanied by speckled or faint linear peripheral enhancement. Brain biopsy revealed JC virus infection in oligodendrocytes and balanced infiltration of CD8+ and CD4+ T lymphocytes. We diagnosed progressive multifocal leukoencephalopathy (PML) with controlled inflammation. The finding of CD4/CD8 T cells in the infected PML brain suggested therapeutically valuable immune system involvement, which we decided to preserve by withholding corticosteroids. We treated the patient with risperidone, cytarabine and mefloquine to suppress virus replication, but not with the corticosteroid that is conventionally used in inflammatory PML cases. The patient was discharged three months after admission, and one year later, his score on the Mini-Mental State Examination had recovered to 26/30, from 5/30 on admission.
Department of Neurology and Neurological Science, Tokyo Medical and Dental University, Japan.
Nobuo
N
Sanjo
Satoko
S
Kina
Yukiko
Y
Shishido-Hara
Yurie
Y
Nose
Satoru
S
Ishibashi
Tetsuya
T
Fukuda
Taketoshi
T
Maehara
Yoshinobu
Y
Eishi
Hidehiro
H
Mizusawa
Takanori
T
Yokota
D000998:Antiviral Agents / Q000627:therapeutic use*; D001927:Brain Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000821:virology; D015496:CD4-Positive T-Lymphocytes / Q000473:pathology; D003561:Cytarabine / Q000627:therapeutic use*; D006801:Humans; D007577:JC Virus / Q000187:drug effects; D007564:Japan; D007968:Leukoencephalopathy, Progressive Multifocal / Q000175:diagnosis / Q000188:drug therapy* / Q000821:virology*; D008297:Male; D015767:Mefloquine / Q000627:therapeutic use*; D008875:Middle Aged; D018967:Risperidone / Q000627:therapeutic use*; D016896:Treatment Outcome; D014779:Virus Replication / Q000187:drug effects
D000998:Antiviral Agents; D003561:Cytarabine; D018967:Risperidone; D015767:Mefloquine