A 52-year-old man with HIV infection is brought to the emergency department because of a generalized tonic-clonic seizure that began 1 hour ago. The seizure resolved without treatment en route to the hospital. Medical history obtained from his son discloses that the patient has become increasingly forgetful, agitated, and restless during the past 5 months. He has hypertension and type 2 diabetes mellitus. Medications are lisinopril, insulin, and combined antiretroviral therapy, but he is often noncompliant with his medications. On arrival, he is somnolent and oriented only to person. His temperature is 36.8°C (98.2°F), pulse is 78/min, and blood pressure is 136/68 mm Hg. Cervical and axillary lymphadenopathy is present. Neurological examination shows moderate left hemiparesis with normal tone and no other focal deficits. Hemoglobin concentration is 10.2 g/dL, leukocyte count is 3800/mm3, CD4+ T-lymphocyte count is 148/mm3. An MRI of the brain is shown. Reactivation of which of the following pathogens is most likely responsible for this patient's current symptoms?

Question

Quizplus · Accepted Answer

Eductional Objective: Patients with advanced AIDS can have reactivation of JC virus, which causes progressive multifocal leukoencephalopathy.  This condition usually presents with slowly progressive confusion, ataxia, and motor deficits.  Brain MRI reveals multifocal areas of white matter demyelination with no mass effect or enhancement.

A 52-Year-Old Man with HIV Infection Is Brought to the Emergency