Management of Progressive Multifocal Leukoencephalopathy - Immune Reconstitution Inflammatory Syndrome (PML-IRIS) In a HIV Positive Male with Steroidal Support and Antiretroviral Therapy with Greater CNS Penetration-Effectiveness Score (CPE): A Case

Abstract

Introduction: We present a case of Progressive Multifocal Leukoencephalopathy (PML) associated with Immune Reconstitution Inflammatory Syndrome (IRIS) in a male aged 47 year diagnosed with AIDS and a CD4 count of 44/μL who was treated with steroidal support and antiretroviral therapy with greater CNS penetration-effectiveness score (CPE). Case Presentation: A 47-year-old male diagnosed with HIV-1 with AIDS who was started on antiretroviral therapy (ART) presented with confusion, disorientation and inability to walk 10 days after ART initiation with Tenofovir, Emtricitabine, and Efavirenz. History revealed progressive fatigue and weakness. On examination, he was hypotonic with slurring of speech. PML was diagnosed based on MRI and positive JC virus PCR in CSF. This posed a clinical dilemma as to whether this was PML alone or PML-IRIS. Management and outcome: Based on clinical judgment, PML-IRIS was diagnosed. Prednisolone was added to help reduce inflammation. On account of better CNS penetration, Tenofovir, Emtritabine, and Efavirenz was switched to Zidovudine. Lamivudine and Efavirenz. Over a period of three months he made rapid progress and completely regained consciousness, orientation with coherent speech. He was able to walk without support and is now preparing to return to work as a civil engineer. Discussion: 1.1. Distinguishing between PML and PML-IRIS can be challenging. It is important nonetheless since management differs. This case report is among the first from India to highlight this entity and its clinical management. We strongly believe that in our patient early initiation of corticosteroids resulted in dramatic improvement. Once initiated steroids probably need to be continued for 6-8 weeks. Citation: Abraham RR, Anand AK, Prasad R, Rao BC, Pillala P (2018) Management of Progressive Multifocal Leukoencephalopathy Immune Reconstitution Inflammatory Syndrome (PML-IRIS) In a HIV Positive Male with Steroidal Support and Antiretroviral Therapy with Greater CNS Penetration-Effectiveness Score (CPE): A Case Report. Curr Trends Intern Med 2: 113. DOI: 10.29011/2638-003X.100013 2 Volume 2; Issue 03