Progressive multifocal leukoencephalopathy (PML)

Case contributed by Dr Alexandra Stanislavsky

Presentation

Acutely worsening confusion in HIV patient who had been non-compliant with anti-retroviral therapy. CD4 count 15. Further history of chronic liver disease secondary to Hep C.

Patient Data

Age: 50
Gender: Male

Multifocal, bilateral, but asymmetric areas of T2 hyperintensity involving the periventricular and deep white matter, with involvement of subcortical U fibres.

Importantly, there is no mass effect or enhancement associated with these lesions.

Note also, bilateral basal ganglia T1 hyperintensity associated with background chronic liver disease.

Case Discussion

PML is a multifocal demyelinating disorder in advanced immunocompromised patients.

Asymmetry is a key feature differentiating from HIV encephalopathy. Lack of mass effect and enhancement separate it from other common differentials in this demographic, such as lymphoma and toxoplasmosis.

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Case Information

rID: 37978
Case created: 28th Jun 2015
Last edited: 12th Jul 2015
Inclusion in quiz mode: Included

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