PMID- 34203265
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20210726
IS  - 2076-0817 (Print)
IS  - 2076-0817 (Electronic)
IS  - 2076-0817 (Linking)
VI  - 10
IP  - 7
DP  - 2021 Jun 28
TI  - Immune Reconstitution Inflammatory Syndrome with Recurrent Paradoxical Cerebellar 
      HIV-Associated Progressive Multifocal Leukoencephalopathy.
LID - 10.3390/pathogens10070813 [doi]
LID - 813
AB  - Progressive multifocal leukoencephalopathy (PML), presenting as immune 
      reconstitution inflammatory syndrome (IRIS), is a known complication of 
      antiretroviral therapy (ART) in people living with HIV (PLWH). Typically preceded 
      by ART initiation, IRIS may appear simultaneously/unmasked (PML-s-IRIS) or as a 
      delayed/worsening/paradoxical (PML-d-IRIS) presentation of known PML disease. 
      Primary cerebellar tropism continues to be a rare presentation, and paradoxical 
      cerebellar involvement of PML-IRIS syndrome can be a challenge for both diagnosis 
      and management. Steroids have been suggested as a possible therapy in severe 
      cases but the duration of steroid therapy remain elusive. Our case is that of a 
      34-year-old man with newly diagnosed HIV simultaneously found to have cerebellar 
      PML. His PML lesions however worsened after initiation of ART (PML-d-IRIS) with 
      evidence of increased intracranial pressure. Despite initial favorable response 
      to a short duration of steroids, he had multiple recurrence of his PML lesions 
      after steroids were discontinued. The presence of predominant cerebellar lesions 
      and the question of how long steroids should be provided to prevent or minimize 
      PML recurrence is the highlight of our case. This report emphasizes the need for 
      more controlled studies to assist clinicians in the optimal diagnosis and 
      management of PML-IRIS in PLWH.
FAU - Frattaroli, Paola
AU  - Frattaroli P
AD  - Jackson Memorial Hospital, 1611 NW 12th Ave, Miami, FL 33136, USA.
FAU - Chueng, Teresa A
AU  - Chueng TA
AD  - Jackson Memorial Hospital, 1611 NW 12th Ave, Miami, FL 33136, USA.
FAU - Abaribe, Obinna
AU  - Abaribe O
AD  - Jackson Memorial Hospital, 1611 NW 12th Ave, Miami, FL 33136, USA.
FAU - Ayoade, Folusakin
AU  - Ayoade F
AUID- ORCID: 0000-0002-3680-1278
AD  - Jackson Memorial Hospital, 1611 NW 12th Ave, Miami, FL 33136, USA.
AD  - Division of Infectious Diseases, University of Miami Miller School of Medicine, 
      Miami, FL 33136, USA.
LA  - eng
PT  - Case Reports
DEP - 20210628
PL  - Switzerland
TA  - Pathogens
JT  - Pathogens (Basel, Switzerland)
JID - 101596317
PMC - PMC8308763
OTO - NOTNLM
OT  - cerebellar PML-IRIS
OT  - paradoxical PML-IRIS
OT  - treatment PML-IRIS
COIS- The authors declare no conflict of interest.
EDAT- 2021/07/03 06:00
MHDA- 2021/07/03 06:01
PMCR- 2021/06/28
CRDT- 2021/07/02 01:16
PHST- 2021/05/22 00:00 [received]
PHST- 2021/06/15 00:00 [revised]
PHST- 2021/06/21 00:00 [accepted]
PHST- 2021/07/02 01:16 [entrez]
PHST- 2021/07/03 06:00 [pubmed]
PHST- 2021/07/03 06:01 [medline]
PHST- 2021/06/28 00:00 [pmc-release]
AID - pathogens10070813 [pii]
AID - pathogens-10-00813 [pii]
AID - 10.3390/pathogens10070813 [doi]
PST - epublish
SO  - Pathogens. 2021 Jun 28;10(7):813. doi: 10.3390/pathogens10070813.