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Washington University Experience | MYELIN (NON-IMMUNE MEDIATED) | Necrotizing Leukoencephalopathy | 2A0 Case 2 History
Case 2 History ---- The patient was a 58 year old man with a history of AIDS (HIV documented positive in 1989) complicated by oral and esophageal candidiasis, encephalopathy and neuropathy, CMV viremia and a history of diabetes mellitus who was admitted in April 1992 with a 3-4 day history of increasing lethargy, decreased PO intake and change in mental status. His last admission in November 1991 was for nausea, increasing wasting and confusion. Cryptococcal antigen and VDRL were nonreactive. MRI of the brain was obtained which revealed multiple small non-enhancing lesions in the midbrain cerebral peduncles, pons, periventricular and deep white matter thought secondary to PML vs. AIDS dementing process itself. He was treated with Mycelex for candidiasis, didanosine (DDI) Rx for HIV infection and foscarnet for CMV. The patient's hospital course from April 16 until his expiration on April 25th was remarkable for progressive obtundation. The patient was treated with care only and expired. It is worth point out that this patient did not have a history of radiation and that the lesions to be presented in the following images were confined to the pons.
