Early diagnosis of progressive multifocal leukoencephalopathy in untreated HIV infection via ultrasensitive PCR testing for JC virus: A case report

IF 1.1 Q4 INFECTIOUS DISEASES
IDCases Pub Date : 2025-01-01 DOI:10.1016/j.idcr.2025.e02229
Kenji Nakano , Akira Kawashima , Takato Nakamoto , Kazuo Nakamichi , Ryo Kuwata , Seitaro Abe , Eri Inoue , Naokatsu Ando , Haruka Uemura , Daisuke Mizushima , Takahiro Aoki , Katsuji Teruya , Hiroyuki Gatanaga
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引用次数: 0

Abstract

Progressive multifocal leukoencephalopathy (PML) is a fatal demyelinating disease triggered by the reactivation of JC virus (JCV) in individuals with immunodeficiency, particularly those with untreated human immunodeficiency virus (HIV) infection. This case report describes a 46-year-old HIV-positive man who initially presented with neurological symptoms and was incorrectly diagnosed as cerebral infarction. Although standard real-time polymerase chain reaction (PCR) testing for JCV in cerebrospinal fluid (CSF) at a commercial laboratory was negative, neuroimaging and clinical suspicion prompted ultrasensitive PCR testing at a national laboratory. This test detected a low viral load of JCV (28 copies/mL), confirming the diagnosis of PML. The patient underwent treatment with antiretroviral therapy and corticosteroids to prevent immune reconstitution inflammatory syndrome; however, his neurological symptoms persisted. This case highlights the importance of ultrasensitive CSF JCV testing for early PML diagnosis when standard PCR tests are inconclusive, particularly in HIV patients with atypically low JCV levels. It also highlights the diagnostic challenges of PML and emphasizes the clinical value of advanced PCR techniques for timely and accurate diagnosis in similar cases.
JC病毒超敏PCR检测早期诊断未经治疗的HIV感染者进行性多灶性脑白质病1例
进行性多灶性白质脑病(PML)是一种致命的脱髓鞘疾病,由免疫缺陷患者,特别是未经治疗的人类免疫缺陷病毒(HIV)感染患者的JC病毒(JCV)再激活引发。本病例报告描述了一名46岁的艾滋病毒阳性男子,他最初表现为神经系统症状,被错误地诊断为脑梗死。尽管商业实验室对脑脊液中JCV的标准实时聚合酶链反应(PCR)检测呈阴性,但神经影像学和临床怀疑促使在国家实验室进行超灵敏PCR检测。该试验检测到低病毒载量的JCV(28拷贝/mL),确认PML的诊断。患者接受抗逆转录病毒治疗和皮质类固醇治疗,以预防免疫重建炎症综合征;然而,他的神经症状持续存在。该病例强调了在标准PCR检测不确定的情况下,超灵敏CSF JCV检测对早期PML诊断的重要性,特别是在典型低JCV水平的HIV患者中。它还强调了PML的诊断挑战,并强调了在类似病例中及时准确诊断先进PCR技术的临床价值。
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来源期刊
IDCases
IDCases INFECTIOUS DISEASES-
CiteScore
2.60
自引率
6.70%
发文量
300
审稿时长
10 weeks
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