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Washington University Experience | NEOPLASMS (HEMATOLYMPHOID) | Lymphoma, immune-compromised | 5A0 Case 5 History
Case 5 History ---- The decedent was a 28 year old man with HIV diagnosed 4 years prior to his death and subsequently diagnosed with AIDS dementia complex. The patient was admitted to BJH in January 1993 with a one week history of increasing headache, lethargy and the new onset of right leg weakness. A brain MRI obtained on admission revealed 3 contrast enhancing lesions located in the superior left parietal lobe, the left subinsular region and the left posterior cerebellum with surrounding edema and extension inferiorly into the left midbrain and pons. It was decided to start the patient on therapy for toxoplasmosis while monitoring him clinically for improvement. During his hospital course the patient developed seizure activity characterized as right focal seizures with secondary generalization. A head CT revealed a slight increase in size and mass effect of the three intracranial lesions. Although the patient was apparently not responding to the toxoplasma treatment it was decided not to proceed with a brain biopsy as he had previously expressed a desire for non-aggressive measures. The patient showed a gradual deterioration in mental status with decreased responsiveness to verbal stimuli. At the end of January 1993 the patient was found unresponsive in bed and pronounced dead. ---- At autopsy the weight of the unfixed brain was 1280 gm. Sections of the basal ganglia revealed scattered multinucleated cells, indicative in this clinical setting of HIV encephalitis. In the white matter generally were scattered axonal spheroids and multinucleated cells consistent with HIV leukoencephalopathy. The section of the pons shows very focal CMV ependymitis. Sections of the spinal cord showed changes of vacuolar myelopathy.
