Aim: To analyse the clinical findings, complementary examinations and prognosis of patients with progressive multifocal leukoencephalopathy (PML) treated in our institution, comparing populations with and without associated human immunodeficiency virus (HIV).
Patients and methods: A retrospective study of the medical records of patients with probable or definite PML was carried out. Clinical variables, complementary studies (cerebrospinal fluid, magnetic resonance imaging of the brain) and prognostic variables were analysed. Non-parametric statistical tests were used to compare HIV-positive and HIV non-positive populations.
Results: Fourteen patients with definite and one probable diagnosis of PML were included. Nine patients had PML associated with HIV; five had other immunosuppressive conditions (two, chronic lymphatic leukaemia; one, multiple sclerosis; one, neuromyelitis optica; and one, neurosarcoidosis); and one, no obvious immunosuppressive condition. The population with HIV presented heterogeneous dirty-appearing white matter lesions more frequently (77.7% versus 16.67%; p = 0.0247) in the cerebral MRI. No other significant differences were identified in the remaining variables analysed.
Conclusion: HIV/AIDS is the pathology most frequently associated with PML. With the use of immunomodulator drugs its appearance is reported in a variety of other diseases. Heterogeneous dirty-appearing white matter lesions were significantly more common in HIV patients.
Title: Espectro clinico de la leucoencefalopatia multifocal progresiva: diferencias y similitudes en pacientes con y sin virus de la inmunodeficiencia humana.
Objetivo. Analizar los hallazgos clinicos, examenes complementarios y pronostico de los pacientes con leucoencefalopatia multifocal progresiva (LMP) atendidos en nuestra institucion, comparando las poblaciones con y sin virus de la inmunodeficiencia humana (VIH) asociado. Pacientes y metodos. Estudio retrospectivo de historias clinicas de pacientes con LMP probable o definitiva. Se analizaron variables clinicas, estudios complementarios (liquido cefalorraquideo, resonancia magnetica cerebral) y variables pronosticas. Mediante pruebas estadisticas no parametricas se realizo la comparacion entre las poblaciones con y sin VIH. Resultados. Se incluyo a 14 pacientes con diagnostico de LMP definitiva y uno probable. Nueve pacientes presentaron LMP asociada a VIH; cinco, otras condiciones de inmunoafectacion (dos, leucemia linfatica cronica; uno, esclerosis multiple; uno, neuromielitis optica; y uno, neurosarcoidosis); y uno, sin condicion inmunosupresora evidente. La poblacion con VIH presento con mayor frecuencia lesiones de la sustancia blanca heterogeneas de aspecto «sucio» (77,7% frente a 16,67%; p = 0,0247) en la resonancia magnetica cerebral. No se identificaron otras diferencias significativas en las restantes variables analizadas. Conclusion. El VIH/sida es la patologia mas frecuente asociada a LMP. Con el uso de farmacos inmunomoduladores se describe su aparicion en una variedad de otras enfermedades. Las lesiones de la sustancia blanca heterogeneas de aspecto «sucio» fueron significativamente mas frecuentes en pacientes con VIH.