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[Pseudotumor lesions induced by infectious agents. Case no. 1]. Ann Pathol 2019; 39:252-255. [PMID: 31104853 DOI: 10.1016/j.annpat.2019.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 03/05/2019] [Accepted: 03/07/2019] [Indexed: 11/20/2022]
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Maillart E, Taoufik Y, Gasnault J, Stankoff B. Leucoencefalopatia multifocale progressiva. Neurologia 2018. [DOI: 10.1016/s1634-7072(18)89404-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Fournier A, Martin-Blondel G, Lechapt-Zalcman E, Dina J, Kazemi A, Verdon R, Mortier E, de La Blanchardière A. Immune Reconstitution Inflammatory Syndrome Unmasking or Worsening AIDS-Related Progressive Multifocal Leukoencephalopathy: A Literature Review. Front Immunol 2017; 8:577. [PMID: 28588577 PMCID: PMC5440580 DOI: 10.3389/fimmu.2017.00577] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 05/01/2017] [Indexed: 12/26/2022] Open
Abstract
Incidence of progressive multifocal leukoencephalopathy (PML) in HIV-infected patients has declined in the combined antiretroviral therapy (cART) era although a growing number of acquired immunodeficiency syndrome (AIDS)-related PML-immune reconstitution inflammatory syndromes (PML-IRIS) have been published during the same period. Therapeutic management of PML-IRIS is not consensual and mainly relies on corticosteroids. Our main aim was, in addition to provide a thoughtful analysis of published PML-IRIS cases, to assess the benefit of corticosteroids in the management of PML-IRIS, focusing on confirmed cases. We performed a literature review of the 46 confirmed cases of PML-IRIS cases occurring in HIV-infected patients from 1998 to September 2016 (21 unmasking and 25 paradoxical PML-IRIS). AIDS-related PML-IRIS patients were mostly men (sex ratio 4/1) with a median age of 40.5 years (range 12-66). Median CD4 T cell count before cART and at PML-IRIS onset was 45/μl (0-301) and 101/μl (20-610), respectively. After cART initiation, PML-IRIS occurred within a median timescale of 38 days (18-120). Clinical signs were motor deficits (69%), speech disorders (36%), cognitive disorders (33%), cerebellar ataxia (28%), and visual disturbances (23%). Brain MRI revealed hyperintense areas on T2-weighted sequences and FLAIR images (76%) and suggestive contrast enhancement (87%). PCR for John Cunningham virus (JCV) in cerebrospinal fluid (CSF) was positive in only 84% of cases; however, when performed, brain biopsy confirmed diagnosis of PML in 90% of cases and demonstrated histological signs of IRIS in 95% of cases. Clinical worsening related to PML-IRIS and leading to death was observed in 28% of cases. Corticosteroids were prescribed in 63% of cases and maraviroc in one case. Statistical analysis failed to demonstrate significant benefit from steroid treatment, despite spectacular improvement in certain cases. Diagnosis of PML-IRIS should be considered in HIV-infected patients with worsening neurological symptoms after initiation or resumption of effective cART, independently of CD4 cell count prior to cART. If PCR for JCV is negative in CSF, brain biopsy should be discussed. Only large multicentric randomized trials could potentially demonstrate the possible efficacy of corticosteroids and/or CCR5 antagonists in the management of PML-IRIS.
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Affiliation(s)
- Anna Fournier
- Department of Infectious and Tropical Diseases, CHU Côte de Nacre, Caen, France
| | - Guillaume Martin-Blondel
- Department of Infectious and Tropical Diseases, CHU Toulouse, Toulouse, France.,INSERM U1043 - CNRS UMR 5282, Université Toulouse III, Centre de Physiopathologie Toulouse-Purpan, Toulouse, France
| | | | - Julia Dina
- Department of Virology, CHU Côte de Nacre, Caen, France
| | | | - Renaud Verdon
- Department of Infectious and Tropical Diseases, CHU Côte de Nacre, Caen, France
| | - Emmanuel Mortier
- Department of Internal Medicine, Hôpital Louis Mourier, Colombes, France
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Gasnault J, de Goër de Herve MG, Michot JM, Hendel-Chavez H, Seta V, Mazet AA, Croughs T, Stankoff B, Bourhis JH, Lambotte O, Delfraissy JF, Taoufik Y. Efficacy of recombinant human interleukin 7 in a patient with severe lymphopenia-related progressive multifocal leukoencephalopathy. Open Forum Infect Dis 2014; 1:ofu074. [PMID: 25734144 PMCID: PMC4281783 DOI: 10.1093/ofid/ofu074] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 07/08/2014] [Indexed: 12/24/2022] Open
Abstract
In this study, we report the case of a patient with profound lymphopenia after allogenic bone marrow transplantation who developed severe progressive multifocal leukoencephalopathy. Single-agent recombinant human interleukin-7 therapy was associated with restoration of anti-John Cunningham polyomavirus (JCV) T-cell responses, JCV clearance from cerebrospinal fluid, and a dramatic clinical improvement.
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Affiliation(s)
- Jacques Gasnault
- Department of Internal Medicine , Assistance Publique-Hôpitaux de Paris (AP -HP), Hôpital Bicêtre , Le Kremlin-Bicêtre , France ; Institut National de la Santé et de la Recherche Médicale (INSERM) U1012, Faculté de Médecine , Université Paris Sud , Le Kremlin-Bicêtre , France
| | - Marie-Ghislaine de Goër de Herve
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1012, Faculté de Médecine , Université Paris Sud , Le Kremlin-Bicêtre , France
| | - Jean-Marie Michot
- Department of Internal Medicine , Assistance Publique-Hôpitaux de Paris (AP -HP), Hôpital Bicêtre , Le Kremlin-Bicêtre , France ; Department of Haematology , Institut Gustave Roussy , Villejuif , France
| | - Houria Hendel-Chavez
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1012, Faculté de Médecine , Université Paris Sud , Le Kremlin-Bicêtre , France
| | - Vannina Seta
- Department of Internal Medicine , Assistance Publique-Hôpitaux de Paris (AP -HP), Hôpital Bicêtre , Le Kremlin-Bicêtre , France
| | - Anne-Aurélie Mazet
- Department of Virology , AP-HP, Hôpital Paul Brousse , Villejuif , France
| | - Thérèse Croughs
- INSERM-Agence Nationale pour la Recherche sur le SIDA , Paris , France
| | - Bruno Stankoff
- Department of Neurology , AP-HP, Hôpital Tenon , Paris , France
| | - Jean-Henri Bourhis
- Department of Haematology , Institut Gustave Roussy , Villejuif , France
| | - Olivier Lambotte
- Department of Internal Medicine , Assistance Publique-Hôpitaux de Paris (AP -HP), Hôpital Bicêtre , Le Kremlin-Bicêtre , France ; Institut National de la Santé et de la Recherche Médicale (INSERM) U1012, Faculté de Médecine , Université Paris Sud , Le Kremlin-Bicêtre , France
| | - Jean-François Delfraissy
- Department of Internal Medicine , Assistance Publique-Hôpitaux de Paris (AP -HP), Hôpital Bicêtre , Le Kremlin-Bicêtre , France ; Institut National de la Santé et de la Recherche Médicale (INSERM) U1012, Faculté de Médecine , Université Paris Sud , Le Kremlin-Bicêtre , France ; INSERM-Agence Nationale pour la Recherche sur le SIDA , Paris , France
| | - Yassine Taoufik
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1012, Faculté de Médecine , Université Paris Sud , Le Kremlin-Bicêtre , France
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Immunological hallmarks of JC virus replication in multiple sclerosis patients on long-term natalizumab therapy. J Virol 2013; 87:6055-9. [PMID: 23514886 DOI: 10.1128/jvi.00131-13] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Progressive multifocal leukoencephalopathy (PML) is the main adverse effect of natalizumab. Detectable JC virus-specific effector memory T-cell (TEM) responses may indicate ongoing JCV replication. We detected JCV-specific TEM responses in blood of patients with multiple sclerosis (MS) treated with natalizumab, including 2 patients with PML. The frequency of detection of these responses increased with the time on natalizumab. Thus, a subset of MS patients exhibit immunological hallmarks of JCV replication during prolonged natalizumab therapy.
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Abstract
Brain infections are relatively rare, but they are potentially serious and have a poor prognosis. The cornerstone of the diagnosis is cerebrospinal fluid (CSF) analysis. Imaging is not systematic, but the indications of imaging are broad, particularly when faced with suspected focal damage, depending on the characteristics of the patient (child, immunosuppressed patient, geographic origin, etc.). It is based on MRI, which allows for aetiological diagnosis and an extension evaluation. In addition, in a certain number of cases, the type of infection is not known and it is up to the MRI via use of an exhaustive technique to diagnose an infectious origin when faced with a mass syndrome. This technical mastery, associated with knowledge of major brain infections, their method of contamination and their particular appearance on the MRI, should make it possible for the radiologist to fulfill his or her diagnostic role.
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Piza F, Fink MC, Nogueira GS, Pannuti CS, Penalva de Oliveira AC, Vidal JE. JC virus-associated central nervous system diseases in HIV-infected patients in Brazil: Clinical presentations, associated factors with mortality and outcome. Braz J Infect Dis 2012. [DOI: 10.1016/s1413-8670(12)70297-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Gasnault J, Costagliola D, Hendel-Chavez H, Dulioust A, Pakianather S, Mazet AA, de Goer de Herve MG, Lancar R, Lascaux AS, Porte L, Delfraissy JF, Taoufik Y. Improved survival of HIV-1-infected patients with progressive multifocal leukoencephalopathy receiving early 5-drug combination antiretroviral therapy. PLoS One 2011; 6:e20967. [PMID: 21738597 PMCID: PMC3127950 DOI: 10.1371/journal.pone.0020967] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Accepted: 05/17/2011] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Progressive multifocal leukoencephalopathy (PML), a rare devastating demyelinating disease caused by the polyomavirus JC (JCV), occurs in severely immunocompromised patients, most of whom have advanced-stage HIV infection. Despite combination antiretroviral therapy (cART), 50% of patients die within 6 months of PML onset. We conducted a multicenter, open-label pilot trial evaluating the survival benefit of a five-drug cART designed to accelerate HIV replication decay and JCV-specific immune recovery. METHODS AND FINDINGS All the patients received an optimized cART with three or more drugs for 12 months, plus the fusion inhibitor enfuvirtide during the first 6 months. The main endpoint was the one-year survival rate. A total of 28 patients were enrolled. At entry, median CD4+ T-cell count was 53 per microliter and 86% of patients had detectable plasma HIV RNA and CSF JCV DNA levels. Seven patients died, all before month 4. The one-year survival estimate was 0.75 (95% confidence interval, 0.61 to 0.93). At month 6, JCV DNA was undetectable in the CSF of 81% of survivors. At month 12, 81% of patients had undetectable plasma HIV RNA, and the median CD4+ T-cell increment was 105 per microliter. In univariate analysis, higher total and naive CD4+ T-cell counts and lower CSF JCV DNA level at baseline were associated with better survival. JCV-specific functional memory CD4+ T-cell responses, based on a proliferation assay, were detected in 4% of patients at baseline and 43% at M12 (P = 0.008). CONCLUSIONS The early use of five-drug cART after PML diagnosis appears to improve survival. This is associated with recovery of anti-JCV T-cell responses and JCV clearance from CSF. A low CD4+ T-cell count (particularly naive subset) and high JCV DNA copies in CSF at PML diagnosis appear to be risk factors for death. TRIAL REGISTRATION ClinicalTrials.gov NCT00120367.
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Affiliation(s)
- Jacques Gasnault
- Service de Médecine Interne et de Maladies Infectieuses, Hôpital Universitaire de Bicêtre-Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France.
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Stankoff B, Tourbah A, Taoufik Y, Gasnault J. Leucoencefalopatia multifocale progressiva. Neurologia 2010. [DOI: 10.1016/s1634-7072(10)70495-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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[Atypical progressive multifocal leukoencephalopathy (PML) in a patient with pulmonary sarcoidosis]. Rev Neurol (Paris) 2009; 166:341-5. [PMID: 19589551 DOI: 10.1016/j.neurol.2009.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 05/05/2009] [Accepted: 05/18/2009] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of central nervous system due to the JC virus. PML generally occurs in immunocompromised hosts and has a fatal outcome. OBSERVATION We report a case of an atypical PML in a patient with pulmonary sarcoidosis: MRI showed multifocal and punctate contrast enhancements. The diagnostic was made by brain biopsy. CONCLUSION The pathophysiology of this association is probably related to the immunodepression induced by sarcoidosis.
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Terrier B, Hummel A, Fakhouri F, Jablonski M, Hügle T, Gasnault J, Sanson M, Martinez F. [Progressive multifocal leukoencephalopathy in a non-AIDS patient: high efficiency of combined cytarabine and cidofovir]. Rev Med Interne 2007; 28:488-91. [PMID: 17574710 DOI: 10.1016/j.revmed.2007.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2006] [Accepted: 05/21/2007] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Progressive multifocal leukoencephalopathy (PML) is an opportunistic infection of the central nervous system, occurring in immunocompromised patients. Treatment, not codified to date, is more often inefficient with a rapid and fatal deterioration. CASE RECORD A 48-year-old woman, treated with immunosuppressant agents for systemic lupus, presented with PML mimicking neurolupus flare. A complete remission was obtained with cytarabine and cidofovir. CONCLUSION Combined cytarabine and cidofovir appears a promising therapeutic option in PML associated with autoimmune systemic disorders.
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Affiliation(s)
- B Terrier
- Service de Néphrologie Adultes, Hôpital Necker-Enfants-malades, Assistance publique-Hôpitaux de Paris (APHP), Université Paris-Descartes, 75015 Paris, France
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Tardieu M. Conséquences neurologiques de l’infection par le VIH-1 : le point en 2006. Rev Neurol (Paris) 2006; 162:19-21. [PMID: 16446620 DOI: 10.1016/s0035-3787(06)74979-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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