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Washington University Experience | MYELIN (IMMUNE-MEDIATED) | Inflammatory Demyelination | 2A0 Case 2 History
Case 2 History ---- The patient is a 42 year old man with a history of HIV diagnosed in September 2015 following two weeks of encephalopathy. His CD4 count was 198 and viral load was 57,100. The patient was begun on HAART therapy, as well as Bactrim prophylaxis. Over a period of days, he became increasingly forgetful, complained of a headache with light sensitivity in the absence of nausea, vomiting, double vision, neck pain, stiffness, focal numbness or weakness. MR imaging in December 2015 showed numerous, partially ring enhancing T2/FLAIR hyperintense and T1 hypointense lesions within the right and left cerebral hemispheres, and right cerebellar hemisphere. Repeat MR imaging performed 12 days later in December 2015 showed interval enlargement of the numerous cystic, incomplete ring enhancing lesions. Pertinent laboratory studies included a high CSF protein of 184 (15-45, normal range), negative VDRL, normal CSF glucose, and presence of oligoclonal bands. Blastomyces antibody (serum) was additionally negative. IgG-NMO auto-antibodies were negative. PCR for CMV, EBV, HSV, Toxoplasma gondii, and JC virus in the CSF were all negative as were AFB stains. Blood cultures showed no growth. Fungal cultures from the brain biopsy performed were negative; histoplasma antigen and cryptococcus antigen testing in the CSF were negative. Aerobic, and anaerobic cultures of the CSF were negative, as were cultures of the brain biopsy material. Operative procedure: Right frontal brain biopsy.
