Progressive multifocal leukoencephalopathy
Known HIV+. Altered mental state.
Loading Stack -
0 images remaining
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.
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