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[The inefficacy of zidovudine (AZT) in progressive multifocal leukoencephalopathy (PML) associated with the acquired immunodeficiency syndrome (AIDS)].

The clinical case of a patient suffering AIDS who presented a progressive multifocal leukoencephalopathy (PML), diagnosed by CT scan, magnetic resonance imaging (MRI) and cerebral biopsy, is here described. A therapeutic trial was carried out with zidovudine (200 mg/4 hours p.o.) during 75 days. Although this treatment diminished the number of infections, a progression of PML was clinically observed, as well as the appearance of new lesions in the cerebral white matter in the MRI. The inefficacy of zidovudine in PML associated to AIDS is discussed.

Acquired Immunodeficiency Syndrome↗

Progressive multifocal leukoencephalopathy in a patient treated with natalizumab.

We describe the clinical course of a patient with multiple sclerosis in whom progressive multifocal leukoencephalopathy (PML), an opportunistic viral infection of the central nervous system, developed during treatment with interferon beta-1a and a selective adhesion-molecule blocker, natalizumab. The first PML lesion apparent on magnetic resonance imaging was indistinguishable from a multiple sclerosis lesion. Despite treatment with corticosteroids, cidofovir, and intravenous immune globulin, PML progressed rapidly, rendering the patient quadriparetic, globally aphasic, and minimally responsive. Three months after natalizumab therapy was discontinued, changes consistent with an immune-reconstitution inflammatory syndrome developed. The patient was treated with systemic cytarabine, and two months later, his condition had improved.

Adult↗