Ajitesh Ojha's research while affiliated with University of Pittsburgh and other places

Introduction Polymerase chain reaction (PCR) testing of cerebrospinal fluid (CSF) is a sensitive and specific method in diagnosing herpes simplex virus (HSV) encephalitis. However there are increasing reports of false negative HSV PCR. Case description We present a patient in the 9th decade of life with abnormal behavior and focal seizures with MRI showing a right temporal T2 hyperintense non-enhancing lesion with electrographic evidence of right lateralized periodic discharges. CSF analysis and PCR for HSV-1 and 2 yielded negative results twice, and therefore acyclovir was discontinued. Patient initially improved following correction of hyponatremia. Patient however deteriorated and imaging revealed a new right parietal lesion. Third CSF sample showed lymphocytic pleocytosis with positive HSV-1 PCR. Patient improved following antiviral treatment. Discussion Acyclovir treatment should continue in high clinical suspicion scenarios despite negative HSV PCR. We further discuss causes of PCR false negatives and challenges it poses for patient care.

Progressive multifocal leukoencephalopathy (PML) is a life‐threatening central nervous system (CNS) disorder, most commonly described in patients infected with the human immunodeficiency virus (HIV). Limited data exist on its natural history and treatment in solid organ transplant (SOT) recipients. A complication of PML is the immune reconstitution inflammatory syndrome (IRIS), which develops after T‐cell reconstitution and can have severe consequences when it occurs in the CNS. While well‐described in HIV‐infected individuals, its clinical features, diagnosis, and treatment after SOT are largely unknown. We report a case of a kidney transplant recipient who was diagnosed with PML and developed significant worsening of her symptoms upon reduction of immunosuppression. Thallium SPECT showed avid uptake suggestive of lymphoma, but the diagnosis of PML‐IRIS was ultimately established by brain biopsy. She survived with nearly complete restoration of her functional status after a prolonged steroid taper. This article is protected by copyright. All rights reserved.

Neurological emergencies are a significant source of morbidity and mortality in immunocompromised patients. Immunodeficiency can be attributed to congenital and acquired causes. Congenital immunodeficiencies can either be combined with involvement of both cellular and humoral immunity or restricted to impairment of either type. Common combined immunodeficiency syndromes include ataxia telangiectasia, Wiskott Aldrich syndrome, and DiGeorge syndrome whereas X linked agammaglobulinemia and common variable immunodeficiency are characterized by isolated impaired humoral immunity. As opposed to rare patients with congenital immunodeficiencies, acquired immunodeficiencies are much more common. Acquired immunodeficiency is seen in HIV patients, diabetics, and in various patients treated with immunosuppressive, cytotoxic, and antirejection medications (e.g., transplant recipients, patients with autoimmune disorders, and cancer). These people are at increased risk of various neurologic emergencies including opportunistic CNS infections, posterior reversible encephalopathy syndrome (PRES), immune reconstitution inflammatory syndrome (IRIS), epilepsy, and stroke.

Introduction: Since the late 1980s, critical illness myopathy (CIM) and polyneuropathy (CIP) have been increasingly recognized in the intensive care unit (ICU). We explored whether these causes of ICU weakness were now more likely to lead to electrodiagnostic studies (EDX) at our institution than they were 19-20 years earlier. Methods: We reviewed 100 consecutive ICU patients who underwent EDX from 2009-2015 and compared them to a previously reported study population from 1990-1995.(10) Results: Thirty-seven (39%) had CIM, CIP, or both versus 55% in the previous study (p=0.04). Thirty-four (36%) were diagnosed with "traditional" pre-ICU causes of weakness, such as motor neuron disease or Guillain-Barre syndrome, versus 29% in the earlier study (p=0.3). Discussion: CIM and CIP continue to be common disorders that lead to ICU EDX, but their proportion declined compared to 19-20 years earlier, possibly due to the perceived role and selective use of EDX in the ICU. This article is protected by copyright. All rights reserved.