Cerebellar atrophy by the jc virus in a patient with aids

Abstract

JVC causes the progressive multifsocal leukoencephalopathy (PML). At least 5% of AIDS patients may develop PML. However a JVC variant attacks the granular cells of cerebellum only, among patients infected with HIV as well. This rare condition causes a progressive cerebellar syndrome and a marked atrophy of the cerebellum on MRI, without the characteristic lesions in the white matter of the PML. The natural history of this disease causes the death of the patient without having an effective treatment to date. It presents a 34 years old Hispanic man, with dizziness, gait disturbances, and a scanned speech consistent with a cerebellar syndrome of 6 months duration. The brain MRI showed diffuse cerebellar atrophy, noting the absence of white matter lesions. He was diagnosed HIV / AIDS at stage C3, with CD4 + of 52 and a serum viral load of 27,000. He started with antiretroviral therapy (HAART). The CSF was normal except for the PCR positive for the JCV. At 4 months, and despite HAART, the patient had a progression of his cerebellar syndrome, adding a severe vestibular syndrome, characterized by the inability to walk and profuse vomiting. The cerebellar atrophy increased in the brain MRI control. There was a clear recovery of the immunological parameters (CD4+ and HIV serum viral load) at this time.The follow up of the patient at 7 months showed a partial regression of cerebellar symptoms, especially with respect to dizziness and vomiting. 1. Igor J. Koralnik et al. JC Virus Granule Cell Neuronopathy: A Novel Clinical Syndrome Distinct from Progressive Multifocal Leukoencephalopathy. Ann Neurol 2005;57:576–580. 2. R.A. Du Pasquier et al. Productive infection of cerebellar granule cell neurons by JC virus in an HIV individual. Neurology 2003;61:775–782.