DOI: 10.36347/sjams.2020.v08i08.016

Pages: 1874-1876

Progressive multifocal leukoencephalopathy (PMLE) is an AIDS defining disease often arising in HIV (human immunodeficiency virus) disease patients with low CD4 T cell count, and rarely among those with more than 500 CD4 T cell/mm3. Definite diagnosis requires JC Virus (JCV) isolation in cerebrospinal fluid (CSF) or in brain tissue. A 31-year-old man was diagnosed with HIV1, never having any AIDS-defining illness since august’18. Combined antiretroviral therapy was started. In February 2019 right hemiparesis along with cognitive and behaviour disturbances. His CD4 T cell count was of 475/mm3. Brain MRI was done showing asymmetrical demyelinating lesions. Normal cerebrospinal fluid (CSF) findings other than mononuclear pleocytosis. PMLE was diagnosed on the basis of clinical and radiological findings. Treatment should not be delayed when a probable diagnosis exists even if CD4 T cell count is above 500/mm3. Repeated lumbar puncture with JCV determinations should be done in the advent of new/worsen neurological symptoms and evidence of demyelination showed in MRI.