Presentation
Rapid (over months) of cognitive decline.
Patient Data
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Bilateral periventricular and deep white matter relatively symmetric T2/FLAIR hyperintensity present that extends into the right cerebral peduncle, pons and medulla. The areas of abnormality demonstrate no evidence of mass effect or diffusion restriction. Mild diffuse atrophy.
Conclusion: Mild cerebral atrophy and diffuse symmetrical periventricular and deep white matter T2/FLAIR abnormality extending into the left pons, in the setting of HIV infection without treatment and dementia type symptoms, findings would likely be in keeping with HIV encephalopathy. The Less likely differential would be CMV infection. Progressive multifocal leukoencephalopathy (PML) would only be expected to be seen in patients with treatment.
The following serological test results were obtained, confirming the patient to be HIV +ve, with a low CD4+ count.
- HIV
- HIV-1/2 Antibody by EIA : DETECTED
- HIV-1 Antibody by Western Blot : DETECTED
- HIV-2 Antibody by Western Blot : Not detected
- CRYPTOCOCCAL SEROLOGY (Serum) - Cryptococcal Ag: NOT Detected
- Strongyloides Serology - Strongyloides IgG by EIA : Negative
- JC negative
- T-CELL SUBSETS
- Total WCC 2.50 x10^9/L (normal = 4.00-11.00)
- Total Lymph 0.50 x10^9/L (normal = 1.20-4.00)
- % CD3 61.20%
- Total CD3 0.31 x10^9/L (normal = 0.70-3.58)
- % CD4 6.50%
- Total CD4 0.03 x10^9/L (normal = 0.35-2.63)
- % CD8 54.00%
- Total CD8 0.27x10^9/L (normal = 0.12-1.47)
- CD4:CD8 0.12L (normal = 1.00-2.40)
Case Discussion
This case illustrates fairly typical changes of HIV encephalopathy (aka AIDS dementia complex).