AIDS-related progressive multifocal leukoencephalopathy in a patient presenting with cerebellar ataxia

摘要

A 30-year-old man with a history of acquired immunodeficiency syndrome (AIDS) (CD4=13 cells/mm3 ) on antiretroviral therapy for one year presented with truncal weakness for four months, followed by involuntary movement of the right upper and lower limbs and slurred speech a month later. He has since started using a wheelchair. Upon examination, he denied symptoms of increased intracranial pressure or prior head trauma. Further examination revealed nystagmus; scanning speech; and intentional tremor, hypertonia, and hyperreflexia of the right upper and lower limbs. Brain magnetic resonance imaging revealed multiple hypointense lesions in the subcortical and deep white matter involving the bilateral parietal, frontal, and occipital lobes; pons; cerebellar peduncle; and cerebellum (Figure 1). Imaging findings suggested progressive multifocal leukoencephalopathy (PML). Lumbar puncture was performed, and JC virus DNA was detected in the cerebrospinal fluid by polymerase chain reaction. Antiretroviral therapy was continued, and the patient was discharged to home after symptom improvement.