A case of progressive multifocal leukoencephalopathy with HIV positivity

Abstract

Background And Aims: We report a case of progressive multifocal leukoencephalopathy with HIV positive. We analyzed her epidemiology, clinical manifestation, neuroimaging and laboratory test. Methods: The 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 ago, he suddenly couldn't recognize his routine home way for several minutes. 2 months ago, he felt dizzy and weak on his left upper limb. 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 bilateral vision suddenly got blind. 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. 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. Results: He was diagnosed as progressive multifocal leukoencephalopathy and HIV infection. 1 month later, he was dead. Conclusions: The 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.