0
ARTICLE |

Progressive Multifocal Leukoencephalopathy in AIDS FREE

Richard E. Chaisson, MD; Diane E. Griffin, MD, PhD
[+] Author Affiliations

Reprint requests to Meyer 6-181, The Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21205 (Dr Griffin).


JAMA. 1990;264(1):79-82. doi:10.1001/jama.1990.03450010083036
Text Size: A A A
Published online

CASE PRESENTATION  —John Williams, MDA 42-YEAR-OLD bisexual, white man presented complaining of progressive memory loss, confusion, and difficulty speaking for 1 week. The patient had been diagnosed with acquired immunodeficiency syndrome (AIDS) a year earlier when he developed cutaneous Kaposi's sarcoma. Three months before admission, Pneumocystis pneumonia was diagnosed and treated. At that time, radiation therapy for his cutaneous Kaposi's lesions was performed. A month prior to admission, he was found to have Kaposi's sarcoma of the upper gastrointestinal tract.On admission he denied fever, sweats, headache, stiff neck, photophobia, seizures, or focal weakness. His medications were a combination product of sulfamethoxazale and trimethoprim and clotrimazole troches. Physical examination showed a temperature of 37°C; pulse rate, 82 beats per minute; blood pressure, 127/79 mm Hg; and respirations, 18/min. Notable physical findings included the cutaneous lesions of Kaposi's sarcoma, a 2/6 systolic ejection murmur at the left sternal border, and

REFERENCES

Rosenblum ML, Levy RM, Bredesen DE, eds. AIDS and the Nervous System . New York, NY: Raven Press; 1988;.
Cohn JA, Meeking MC, Cohen W, et al.  Evaluation of the policy of empiric treatment of suspected Toxoplasma encephalitis in patients with the acquired immunodeficiency syndrome . Am J Med. 1989;;86:521-527.
Astrom KE, Mancall EL, Richardson EP Jr.  Progressive multifocal leukoencephalopathy: a hitherto unrecognized complication of chronic lymphatic leukemia and Hodgkin's disease . Brain . 1958;;81:93-111.
ZuRhein G, Chou SM.  Particles resembling papovaviruses in human cerebral demyelinating disease . Science . 1965;;148:1477-1479.
Padgett BL, Walker DL, ZuRhein GM, Eckroade RJ.  Cultivation of papovavirus-like virus from human brain with progressive multifocal leucoencephalopathy . Lancet . 1971;;1:1257-1260.
Arthur RR, Shah KV, Baust SJ, Santos GW, Saral R.  Association of BK viruria with hemorrhagic cystitis in recipients of bone marrow transplant . N Engl J Med. 1986;;315:230-234.
Walker DL, Padgett BL.  The epidemiology of human polyomaviruses . In: Polyomaviruses and Human Neurological Diseases . New York, NY: Alan R Liss Inc; 1983;:99-106.
Berger JR, Kaszovitz B, Post JD, Dickinson G.  Progressive multifocal leukoencephalopathy associated with human immunodeficiency virus infection: a review of the literature with a report of sixteen cases . Ann Intern Med. 1987;;107:78-87.
Chesters PM, Heritage J, McCance DJ.  Persistence of DNA sequences of BK virus and JC virus in normal human tissues and in diseased tissues . J Infect Dis. 1983;;147:676-684.
Houff SA, Major EO, Katz DA, et al.  Involvement of JC-infected mononuclear cells from the bone marrow and spleen in the pathogenesis of progressive multifocal leukoencephalopathy . N Engl J Med. 1988;;318:301-305.
Small JA, Scangos GA, Cork L, Jay G, Khoury G.  The early region of human papovavirus JC induces dysmyelination in transgenic mice . Cell. 1986;;46:13-18.
Trapp BD, Small JA, Pulley M, et al.  Dysmyelination in transgenic mice containing JC virus early region . Ann Neurol. 1988;;23:38-48.
Berger JR, Mucke L.  Prolonged survival and partial recovery in AIDS-associated progressive multifocal leukoencephalopathy . Neurology . 1988;; 38:1060-1065.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

Rosenblum ML, Levy RM, Bredesen DE, eds. AIDS and the Nervous System . New York, NY: Raven Press; 1988;.
Cohn JA, Meeking MC, Cohen W, et al.  Evaluation of the policy of empiric treatment of suspected Toxoplasma encephalitis in patients with the acquired immunodeficiency syndrome . Am J Med. 1989;;86:521-527.
Astrom KE, Mancall EL, Richardson EP Jr.  Progressive multifocal leukoencephalopathy: a hitherto unrecognized complication of chronic lymphatic leukemia and Hodgkin's disease . Brain . 1958;;81:93-111.
ZuRhein G, Chou SM.  Particles resembling papovaviruses in human cerebral demyelinating disease . Science . 1965;;148:1477-1479.
Padgett BL, Walker DL, ZuRhein GM, Eckroade RJ.  Cultivation of papovavirus-like virus from human brain with progressive multifocal leucoencephalopathy . Lancet . 1971;;1:1257-1260.
Arthur RR, Shah KV, Baust SJ, Santos GW, Saral R.  Association of BK viruria with hemorrhagic cystitis in recipients of bone marrow transplant . N Engl J Med. 1986;;315:230-234.
Walker DL, Padgett BL.  The epidemiology of human polyomaviruses . In: Polyomaviruses and Human Neurological Diseases . New York, NY: Alan R Liss Inc; 1983;:99-106.
Berger JR, Kaszovitz B, Post JD, Dickinson G.  Progressive multifocal leukoencephalopathy associated with human immunodeficiency virus infection: a review of the literature with a report of sixteen cases . Ann Intern Med. 1987;;107:78-87.
Chesters PM, Heritage J, McCance DJ.  Persistence of DNA sequences of BK virus and JC virus in normal human tissues and in diseased tissues . J Infect Dis. 1983;;147:676-684.
Houff SA, Major EO, Katz DA, et al.  Involvement of JC-infected mononuclear cells from the bone marrow and spleen in the pathogenesis of progressive multifocal leukoencephalopathy . N Engl J Med. 1988;;318:301-305.
Small JA, Scangos GA, Cork L, Jay G, Khoury G.  The early region of human papovavirus JC induces dysmyelination in transgenic mice . Cell. 1986;;46:13-18.
Trapp BD, Small JA, Pulley M, et al.  Dysmyelination in transgenic mice containing JC virus early region . Ann Neurol. 1988;;23:38-48.
Berger JR, Mucke L.  Prolonged survival and partial recovery in AIDS-associated progressive multifocal leukoencephalopathy . Neurology . 1988;; 38:1060-1065.
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.