Progressive multifocal leukoencephalopathy (PML) presenting as focal seizures in a filipino male with aids a case report

Abstract

A 38-year old male, health care worker presented one month PTA with myoclonic jerks of the left upper extremity lasting approximately one minute associated with left hemiparesis. He was initially managed as cerebrovascular disease (CVD) infarct at a local hospital. Brain plain CT scan and MRI were both unremarkable. Patient was discharged with noted improvement of his motor strength. A week after he developed intermittent fever and recurrence of myoclonic seizures. MRI of the brain plain and contrast showed a non-specific and non - enhancing T2W and FLAIR hyperintensities in the right and left parietal white matter due to small vessel ischemic change or foci of demyelination and temporal lobe volume loss (Fig. 1). His social history revealed MSM (male having sex with male). HIV ELISA was positive and CD4 T-cell count was of 22 cells/ul. Blood Cultures, serum electrolytes and Chest X-ray taken were all unremarkable. Patient was started on combination antiretroviral drug therapy, Azithromycin and Cotrimoxazole and Levetiracetam and discharged. He developed recurrent fever, headache, left sided hemiparesis, blurring of vision, focal seizures and progressive deterioration of sensorium and was readmitted. Empiric Ceftriaxone, IV Valproic Acid and Levetiracetam were started.CSF samples were sent for cultures and film array ®assay for meningitis and encephalitis, India ink and TB gene Expert were all negative (Table 1). CSF Polymerase Chain Reaction (PCR) for JC virus was positive. He deteriorated, became comatose and eventually succumbed on the 3rdweek of admission.