An Atypical Presentation of Progressive Multifocal Leukoencephalopathy With Newly Diagnosed HIV Infection

Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating infectious disease of the central nervous system that typically presents in immunosuppressed patients with history of AIDS, hematologic malignancies, or immunosuppressant drug treatment. We report a case that highlights the imp...

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Bibliographic Details
Main Authors: Kishan V. Patel, Abhishek Dutta, Marcela K. Roger
Format: Article
Language:English
Published: American College of Physicians 2023-01-01
Series:Annals of Internal Medicine: Clinical Cases
Online Access:https://www.acpjournals.org/doi/10.7326/aimcc.2022.0809
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Summary:Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating infectious disease of the central nervous system that typically presents in immunosuppressed patients with history of AIDS, hematologic malignancies, or immunosuppressant drug treatment. We report a case that highlights the importance of differentiating PML from acute/chronic ischemic stroke. Distinction is made between acute ischemic stroke and demyelinating disease with the T2-gradient recalled-echo weighted imaging. Failure to test for HIV in patients with suspected chronic ischemic stroke can lead to increased morbidity, decreased highly active antiretroviral therapy efficacy, and poorer patient outcomes. Clinicians should strongly consider PML in immunocompromised patients with frequent, progressive neurologic symptoms.
ISSN:2767-7664