Akinetic Mutism Caused by HIV-associated Progressive Multifocal Leukoencephalopathy was Successfully Treated with Mefloquine: A Serial Multimodal MRI Study

Kasane Naito; Hiroki Ueno; Mayu Sekine; Munekazu Kanemitsu; Tomohiko Ohshita; Takeshi Nakamura; Takemori Yamawaki; Masayasu Matsumoto

doi:10.2169/internalmedicine.51.6253

CASE REPORTS

Akinetic Mutism Caused by HIV-associated Progressive Multifocal Leukoencephalopathy was Successfully Treated with Mefloquine: A Serial Multimodal MRI Study

Kasane Naito, Hiroki Ueno, Mayu Sekine, Munekazu Kanemitsu, Tomohiko Ohshita, Takeshi Nakamura, Takemori Yamawaki, Masayasu Matsumoto

Author information

Kasane Naito
Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Graduate School of Biomedical Sciences, Japan
Department of Neurology, Hiroshima City Hospital, Japan
Hiroki Ueno
Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Graduate School of Biomedical Sciences, Japan
Mayu Sekine
Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Graduate School of Biomedical Sciences, Japan
Department of Neurology, Tokyo Saiseikai Central Hospital, Japan
Munekazu Kanemitsu
Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Graduate School of Biomedical Sciences, Japan
Tomohiko Ohshita
Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Graduate School of Biomedical Sciences, Japan
Department of Neurology, Suiseikai Kajikawa Hospital, Japan
Takeshi Nakamura
Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Graduate School of Biomedical Sciences, Japan
Takemori Yamawaki
Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Graduate School of Biomedical Sciences, Japan
Masayasu Matsumoto
Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Graduate School of Biomedical Sciences, Japan

Keywords: progressive multifocal leukoencephalopathy (PML), human immunodeficiency virus infection (HIV), highly active anti-retroviral therapy (HAART), mefloquine, proton magnetic resonance spectroscopy (¹H-MRS), apparent diffusion coefficient (ADC)

JOURNAL OPEN ACCESS

2012 Volume 51 Issue 2 Pages 205-209

DOI https://doi.org/10.2169/internalmedicine.51.6253

Details

Abstract

We report a case of a patient with highly active anti-retroviral therapy-resistant human immunodeficiency virus (HIV)-associated progressive multifocal leukoencephalopathy (PML). The patient showed an improvement in imaging findings and clinical symptoms after mefloquine was introduced as an additional treatment. Serial assessment of white matter lesions was conducted by proton magnetic resonance spectroscopy (¹H-MRS) and diffusion-weighted imaging (DWI). As the clinical symptoms improved, the N-acetylaspartate/creatine ratio increased, the choline/creatine ratio decreased, and the elevated ADC value decreased. These concomitant changes suggested that ¹H-MRS and DWI were useful for the assessment of the therapeutic effect on PML.

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