Tumefactive demyelination in a patient with human immunodeficiency virus

Abstract

The brain is a common target of HIV infection, and may be damaged through direct and indirect effects of the virus. White matter changes including HIV leukoencephalopathy and vacuolar myelopathy are often seen (Gray and Lescs, 1993). Increased susceptibility to a wide variety of pathogens (CMV, tuberculosis, syphilis, cryptococcus, toxoplasma, JCV, etc.) and neoplastic processes (primary CNS lymphoma) occurs when CD4+ cell counts are greatly diminished. In rare cases, HIV infection has been associated with tumefactive demyelination (TD), a disorder distinct from either multiple sclerosis (MS) or acute disseminated encephalomyelitis (ADEM). Radiologically, TD consists of an incomplete rim enhancing “tumor-like” lesion (Ball, 2004; Saravanan and Turnbull, 2009; Uriel et al., 2010). We present the neurologic, radiologic, and pathologic findings with one year of follow-up from a patient who presented with neuroimaging findings consistent with TD and who was concomitantly diagnosed with HIV.