Progressive multifocal leukoencephalopathy with immune reconstitution inflammatory syndrome (PML-IRIS): Two case reports of successful treatment with mefloquine and a review of the literature

摘要

Failure of cell-mediated immunity allows reactivation of the ' JC' polyomavirus (JCV) in oligodendrocytes, and the development of progressive multifocal leukoencephalopathy (PML). This is most commonly associated with advanced human immunodeficiency virus (HIV) infection, but is also described after biological therapies such as natalizumab, and rarely other conditions. In the early years of HIV treatment, PML frequently resulted in death irrespective of medical interventions. The development of antiretroviral therapy (ART) has greatly improved this prognosis. In the Swiss Cohort Study, incidence fell 4-fold and attributable 1-year mortality fell from 60% to 20%. Despite these advances, PML still has one of the highest mortality rates among acquired immune deficiency syndrome (AIDS) defining illnesses.