January 12, 2021

Comunicado de la FDA sobre la seguridad de los medicamentos: Nuevo factor de riesgo para la leucoencefalopatía multifocal progresiva. Abstract. PASQUALOTTO, Alessandro Comarú; MATTOS, Alice J.Z. de and ROCHA, Marineide Melo. Leucoencefalopatia multifocal progressiva confirmada por. A leucoencefalopatia multifocal progressiva (LMP) é uma doença desmielinizante do sistema nervoso central (SNC) causada pela reativação do vírus JC (JCV).

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Primary infection occurs in childhood and it is asymptomatic in most patients. Despite the support leeucoencefalopatia, the patient evolved with clinical multlfocal radiological deterioration Figure 3. Empiric treatment with plasma exchange or immunoadsorption has been tried in an attempt to accelerate the elimination of the monoclonal antibody This is in contradistinction to more symmetrical hypoattenuation seen in HIV encephalopathy.

JC virus granule cell neuronopathy: Author information Article notes Copyright and License information Disclaimer. Stereotactic biopsy was performed and the anatomopathological examination revealed areas of intense demyelination with presence of large oligodendrocytes Immunohistochemistry staining on brain biopsy demonstrated JC virus DNA, characterizing progressive multifocal leukoencephalopathy PML. The clinical picture of PML varies according to the patterns of demyelination.

Leucoencefalopatia Multifocal Progressiva (PML)

Unusual viral infections leucoencefalopatiia multifocal leukoencephalopathy and cytomegalovirus disease after high-dose chemotherapy multifkcal autologous blood stem cell rescue and peritransplantation rituximab. N Engl J Med ; PML can be differentiated from these diseases by its slower temporal evolution, fewer systemic manifestations, multifocxl of fever, preservation of conscience and lack of mass effect, perilesional edema or contrast enhancement on imaging tests.

FLAIR image reveals multifocal and asymmetric progression of PML, with involvement of the left temporal-occipital lobes white arrow and of the subcortical region of the right temporal lobe U-fibers black arrow. BK virus MuV Mumps. Contrast enhancement and edema, denoting blood brain barrier disruption secondary to the inflammatory process, can be observed on MRI. Inflammatory progressive multifocal leukoencephalopathy in human immunodeficiency virus-negative patients.

Support Radiopaedia and see fewer ads. A number of drugs work against JC virus in cell culturebut no proven, effective therapy is known in humans.


This approach frequently results, three to six weeks later, in the development of an intense IRIS due to the restoration of the lymphocyte trafficking into the central nervous system that can be fatal.

Molecular biology, epidemiology, and pathogenesis of progressive multifocal leukoencephalopathy, the JC virus-induced demyelinating disease of the human brain. A prospective study demonstrates an association between JC virus-specific cytotoxic T lymphocytes and the early control of progressive multifocal leukoencephalopathy.

Unsourced material may be challenged and removed. On MRI, lesions are hyperintense on T2-weighted and Fluid attenuated inversion recovery FLAIR sequences and located predominantely in the subcortical white matter of the cerebral hemispheres and cerebellar peduncles 2.

J Neurovirol ;8 Suppl 2: Thank you for updating your details.

During a follow-up visit, he reported speech and visual difficulties. However, some authors believe that the impact of HAART was less evident in PML incidence compared to other central nervous system opportunistic infections 7. Since diagnosis, he had remained asymptomatic and in clinical follow-up, under no specific therapy.

All articles with leuciencefalopatia external links Articles with dead external links from April Articles with permanently dead external links CS1 maint: Journal of Acquired Immune Deficiency Syndromes. It is caused by the reactivation of the JC virus leucoencefaloppatia PML can still occur in people leucoencefalopayia immunosuppressive therapy, such as efalizumab, [7] belatacept, [8] and various transplant drugs, which are meant to weaken the immune system.

Memory loss, visual deficits such as hemianopsia and cortical blindness, sensory-motor alterations, and generalized neurological decline, may also occur.

Clin Microbiol Rev ; Open in a separate window. PML is diagnosed in a patient with a progressive course of the disease, finding JC virus DNA in spinal fluid together with consistent white-matter lesions on brain magnetic resonance imaging MRI ; alternatively, a brain biopsy is diagnostic [1] when the typical histopathology of demyelination, bizarre astrocytes, and enlarged oligodendroglial nuclei are present, coupled with techniques showing the presence of JC virus.

The Journal of Infectious Diseases.

Some reports also state some benefit with cytarabine or mirtazapine, the latter especially in natalizumab-associated PML. Views Read Edit View history.

Leucoencefalopatia Multifocal Progressiva (PML) :

Survivors can be left with variable degrees of neurological disability. November Learn how and when to remove this template message. National Institutes of Health. In the last years, several monoclonal antibodies and other particles designed to act on specific steps of the immune response have been designed and used in the treatment of malignancies and autoimmune diseases multiple sclerosis, Crohn’s disease, psoriasis, systemic erythematous lupus.


The virus causes disease only when the immune system has been severely weakened. Although the concept sounds attractive and the drug is usually well tolerated, the evidence to date is scarce and based mostly in case reports and small series PML occurs almost exclusively in patients with severe immune deficiencymost commonly among patients with acquired immune deficiency syndrome AIDSbut people on chronic immunosuppressive medications including chemotherapy are also at increased risk of PML, such as patients with transplants, Hodgkin’s lymphomamultiple sclerosispsoriasisand other autoimmune diseases.

However, other causes of immunosuppression such as organ transplantation, chemotherapy, immunotherapies with monoclonal antibodies, autoimmune diseases and lymphoma, may also be associated with PML.

Clinically, the development of PML in multiple sclerosis patients poses an additional difficulty in the diagnosis, since PML onset is frequently mistaken with MS exacerbation, stroke or other neurological condition More recently, the introduction of new immunomodulatory and immunosuppressive drugs Table 1 in the treatment of tumors and autoimmune diseases expanded the spectrum of conditions associated with PML as described below 1 10 However, there is evidence that some antiretroviral classes may have an additional benefit over others.

Progressive multifocal leukoencephalopathy associated with efalizumab use in psoriasis patients. Immunomodulatory agents associated with PML. Brain disorders Mental disorders due to a general leucoencefalopatoa condition Viral infections of the central nervous system Rare diseases Slow virus diseases Rare infectious diseases.

However, isolated posterior fossa involvement has also been reported Articles Cases Courses Quiz. N Engl J Med ; Cidofovir was studied as possible treatment for PML [15] and has been used on leucoencefalopqtia case-by-case basis, working in some, but not others.

Clinical outcome of long-term survivors leucoencefalopatoa progressive multifocal leukoencephalopathy.