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

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.