Progressive multifocal leukoencephalopathy by JC Polyomavirus as an initial manifestation of HIV
Keywords:
INFECCIONES POR VIH; LEUCOENCEFALOPATÍA MULTIFOCAL PROGRESIVA; VIRUS JC.; HIV INFECTIONS; LEUKOENCEPHALOPATHY, PROGRESSIVE MULTIFOCAL; JC VIRUS.; INFECÇÕES POR HIV; LEUCOENCEFALOPATIA MULTIFOCAL PROGRESSIVA; VÍRUS JC.Abstract
Introduction: progressive multifocal leukoencephalopathy is a demyelinating disease of the central nervous system caused by the reactivation of the JC polyomavirus, which typically occurs in contexts of severe immunosuppression. Its clinical presentation is often devastating and evolves rapidly towards disability and death.
Objective: to present a clinical case of fulminant neurological onset associated with advanced HIV infection, illustrating the importance of early diagnosis and timely access to comprehensive treatment.
Case presentation: we present the case of a 36-year-old male with no medical history, who consulted for progressive weakness in the right hemibody, dysarthria, and behavioral changes. The neurological examination confirmed right hemiparesis and decreased level of attention. Serology revealed HIV infection with a viral load >750,000 copies/mL and CD4 T-cells at 18 cells/mm³. Brain MRI showed bilateral parieto-occipital white matter lesions, without enhancement or mass effect, compatible with PML. PCR in cerebrospinal fluid was positive for JC polyomavirus, ruling out other opportunistic infections. Antiretroviral treatment was initiated under surveillance for IRIS and neurorehabilitation support. The patient presented progressive neurological deterioration and died three weeks after admission.
Conclusions: this case illustrates a form of fulminant neurological onset of advanced HIV, with irreversible evolution. The fatal outcome underscores the urgency of public health strategies aimed at early detection and reduction of severe immunosuppression in patients with HIV.
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