A rational approach to PML for the clinician

June 30, 2012 at 1:54 pm

Cleveland Clinic Journal of Medicine Nov. 2011 V.78 N. Suppl.2 P.

LEONARD CALABRESE

Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University;R.J. Fasenmyer Chair of Clinical Immunology, Department of Rheumatic and Immunologic Diseases, Orthopaedic & Rheumatologic Institute, Cleveland Clinic, Cleveland, OH

The first step in the management of progressive multifocal leukoencephalopathy (PML) is awareness of the disease. Patients vulnerable to PML are those with immunosuppression, either through their disease or use of immune-modulating therapy. In patients susceptible to PML who exhibit focal neurologic signs and symptoms, brain magnetic resonance imaging can detect the telltale PML brain lesions—subcortical white matter hyperintense areas on T2-weighted images and fluid-attenuated inversion recovery sequences and hypointensity on T1-weighted images, typically without enhancement. Demonstration of JC virus DNA by ultrasensitive polymerase chain reaction in cerebrospinal fluid is diagnostic for PML. Immune restoration whenever possible is the cornerstone of treatment. Highly active antiretroviral therapy has dramatically improved the prognosis for patients infected with human immunodeficiency virus. Alternatively, restoration of immunity is frequently attended by the immune reconstitution inflammatory syndrome which can be clinically devastating or even fatal. In the case of natalizumab-associated PML, withdrawal of therapy and prompt institution of plasmapheresis to desaturate target receptors provides the best chance for long-term survival.

PDF

http://www.ccjm.org/content/78/Suppl_2/S38.full.pdf+html

Advertisements

Entry filed under: Biología Molecular, HIV/SIDA, HIV/SIDA Complicaciones, HIV/SIDA Infecciones Oportunistas, HIV/SIDA Laboratorio, Infecciones virales, Metodos diagnosticos.

Incidence of endophthalmitis after cataract surgery (2002-2008) at a Brazilian university-hospital. Acute Hepatitis B and Acute HIV Coinfection in an Adult Patient: A Rare Case Report.


Calendar

June 2012
M T W T F S S
« May   Jul »
 123
45678910
11121314151617
18192021222324
252627282930  

Most Recent Posts


%d bloggers like this: