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Washington University Experience | INFECTION | Viruses | PML (JC Virus) | PML - IRIS | 4A0 Case 4 History
Case 4 History ---- A 38 year old homosexual male with AIDS presented with language problems and confusion for 1 month. The patient was alert, but yawned frequently and unable to follow complex directives. His CD4 cell count was 180. MRl of the head revealed multiple lesions involving bilateral subcortical white matter, some of which were enhancing. The most prominent lesion, however, was a wedge-shaped area of abnormal signal in the left parietal lobe, without enhancement or significant mass effect. Lumbar puncture revealed clear CSF, WBC I, Protein 33, and glucose 54. AFB smear and cryptococcal antigen were negative. CSF cultures were sterile. Repeat MRI 4 weeks later revealed progression of the large white matter lesion with new enhancement and significant mass effect. At that time, the patient had gait and balance disturbances with progression of his language problems. The patient was admitted for brain biopsy, however, he was found unresponsive with dilated pupils the next morning and was pronounced dead.(AANP Diagnostic Slide Session 1997, Case 5)
