Unmasking the Truth: Progressive Multifocal Leukoencephalopathy-Immune Reconstitution Inflammatory Syndrome (PML-IRIS) in a 36-year Old Male with HIV, A Case Report

Abstract

Jon Stewart H. Dy, Samantha Anne S. Gutierrez, Ryan M. Llorin, Mercedes De Leon Dizon, Eric Gerard Maglaya and Ludwig F. Damian

Progressive Multifocal Leukoencephalopathy

Immune Reconstitution Inflammatory Syndrome (PMLIRIS) is the subacute onset of neurological deficits that appeared or was exacerbated after initiation antiretroviral therapy (ART) for treatment of PML. It is due to severe neuroinflammation with re- establishment of immunocompetence. Approximately 25% of patients with HIV and PML develop IRIS. Clinical trials on the treatment of PML-IRIS is lacking with only limited evidence supporting the use of investigative therapies such as corticosteroids and Maraviroc. We report a case of a 36-year old Filipino male, known hypertensive and diagnosed with HIV, who presented with memory problems. He was eventually treated as a case of PML-IRIS on the 3rd week after initiation of ART. He was treated with a course of intravenous Dexamethasone, oral Mefloquine and intravenous immunoglobulin, and ART was continued. Clinical outcome in our patient shows an overall improvement of symptoms and no deterioration of neurologic deficits.

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