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The “milky way” galaxy of HIV-related central nervous system immune reaction syndromes

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Abstract

The landscape of central nervous system HIV infection is rapidly changing, leading to the recognition of a new constellation of overlapping syndromes and to a better insight for the elder ones. Among these, progressive multifocal leukoencephalopathy (PML) still poses several diagnostic and therapeutic challenges; nevertheless, recent developments in understanding PML in patients with multiple sclerosis may have benefitted HIV-positive patients suffering from PML too. We describe a peculiar case of PML–immune reconstitution inflammatory syndrome (IRIS) presenting a punctate pattern with “milky way” appearance on magnetic resonance imaging. Despite the fact that brain imaging and histopathology remain the mainstays for extricating through the expanding galaxy of HIV-related central nervous system dysimmune syndromes and although punctate pattern has been already well acknowledged as a suggestive finding of PML among patients on natalizumab, this radiological presentation is still poorly recognised in AIDS-related PML cases, leading to possible life-threatening diagnostic delays. This is also the first report about intravenous immunoglobulin treatment in AIDS-related PML-IRIS; the favourable clinical and radiological outcome of our case and the preliminary administrations of intravenous immunoglobulins in natalizumab-associated PML-IRIS from literature support probable benefits also among HIV-positive patients.

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Authors and Affiliations

  1. Unit of Infectious Diseases, Department of Medical Sciences, Amedeo di Savoia Hospital, University of Torino, Corso Svizzera 164, 10149, Torino, Italy

    Mattia Trunfio, Alice Trentalange, Sabrina Audagnotto, Stefano Bonora, Giovanni Di Perri & Andrea Calcagno

  2. Unit of Pathology, San Giovanni Bosco Hospital, Piazza Donatore di Sangue 3, 10154, Torino, Italy

    Claudia Manini & Stefano Taraglio

  3. Unit of Neuroradiology, San Giovanni Bosco Hospital, Piazza Donatore di Sangue 3, 10154, Torino, Italy

    Andrea Boghi

  4. Unit of Neurology, Maria Vittoria Hospital, Via Luigi Cibrario 72, 10144, Torino, Italy

    Daniele Imperiale

Authors
  1. Mattia Trunfio
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  2. Claudia Manini
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  3. Alice Trentalange
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  4. Andrea Boghi
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  5. Sabrina Audagnotto
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  6. Daniele Imperiale
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  7. Stefano Taraglio
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  8. Stefano Bonora
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  9. Giovanni Di Perri
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  10. Andrea Calcagno
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Correspondence to Mattia Trunfio.

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Trunfio, M., Manini, C., Trentalange, A. et al. The “milky way” galaxy of HIV-related central nervous system immune reaction syndromes. J. Neurovirol. 25, 887–892 (2019). https://doi.org/10.1007/s13365-019-00769-4

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  • DOI: https://doi.org/10.1007/s13365-019-00769-4

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