A case of progressive multifocal leukoencephalopathy with HIV positivity

Abstract

AbstractBackgroundWe report a case of progressive multifocal leukoencephalopathy with HIV positive. We analyzed her epidemiology, clinical manifestation, neuroimaging and laboratory test.MethodThe patient was a 36‐year‐old right‐handed man with 4 months of left upper limb numb, 2 months of left limbs weak. 4 months ago, he felt cold on her left upper limb without any reason.3 months agohe suddenly couldn’t recognize his routine home way for several minutes. 2 months ago, he felt dizzy and weak on his left upper limb. He was considered as cervical spondylosis without recover after massage. His brain MRI showed his right frontal and parietal cortex ischemic, right thalamus, corona radiata and callosum ischemic infarction (subacute stage), and posterior angel of bilateral ventricles demyelination. The focus weren’t enhanced on brain enhancement MRI. He got treatment according to cerebral infarction and didn’t relieve. His blood test results showed decreased white cells, red cells and platelet count. His CSF test was normal. His serum NMDA, AQP4 antibody were all negative.1 months ago, he began to have fever and could relieve after cortisone. He couldn’t get better after antiviral therapy according to viral encephalitis. His bilateral vision suddenly got blind. His PET‐CT scan was normal. He didn’t relieve after immune globulin. His nervous system examination showed his cognitive function deceased, left central facial paralysis and left limbs upper motor neuron paralysis. His bilateral light reflex was normal. However both of his eyes couldn’t react on light. His bone marrow aspiration was normal. Finally, he got HIV test and the result was positive. His CSF and urine of JC virus PCR test were 1000000copies/ml and 2000copies/ml.ResultHe was diagnosed as progressive multifocal leukoencephalopathy and HIV infection. 1 month later, he was dead.ConclusionThe syndromes of this case became worse and worse, but he couldn’t get right diagnose and treatment. His brain MRI image seems like ischemic stroke. The most important HIV test was done at the final stage. This case gave us a lesson and we should keep mind on HIV test.