Progressive multifocal leukoencephalopathy

Case contributed by Dr Maxime St-Amant

Presentation

Known HIV+. Altered mental state.

Patient Data

Age: 40
Gender: Male
Modality: MRI

Non specific findings of juxtacortical (subcortical U-fibers) white matter T2/FLAIR hyperintensities involving the precentral gyri at the upper convexity. There are similar hyperintensities in the right thalamic / posterior arm of the internal capsule. These findings are non specific, but in a HIV+ patient, PML is not excluded. The main differential diagnosis would be HIV encephalitis, CMV encephalitis, IRIS (Immune Reconstitution Inflammatory Syndrome), ADEM & multiple sclerosis.

Case Discussion

This case is atypical as the findings are not as extensive as expected in PML. The patient died a few months later.

This patient had a prior brain biopsy which confirmed JC virus infected oligodendrocytes with enlarged amphophilic nuclei located at the periphery of the lesions. Other pathologic findings include :

  • reactive gliosis with enlarged astrocytes
  • macrophages containing phagocytosed cellular debris and myelin

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Case Information

rID: 19175
Case created: 12th Aug 2012
Last edited: 1st Feb 2016
Inclusion in quiz mode: Included

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