Cardiff Medical School, Cardiff, Wales, UK.
Int J Gen Med. 2012;5:331-4. doi: 10.2147/IJGM.S28020. Epub 2012 Apr 13.
A 43-year-old Caucasian homosexual man with AIDS presented with blurring of vision, change of personality, and memory loss in March 1999. He had first been admitted 2 months previously for treatment of Pneumocystis jiroveci pneumonia. A magnetic resonance imaging scan on admission showed multiple white matter lesions involving both subcortical cerebral hemispheres and cerebellar regions, with no mass effect or surrounding edema. JC virus was detected by nested polymerase chain reaction in the cerebrospinal fluid. These findings were diagnostic of progressive multifocal leukoencephalopathy (PML). His CD4 count was 34 cells/mL, and his HIV ribonucleic acid level was 800,789 copies/mL. He was treated with a combination antiretroviral therapy. He was last reviewed in October 2011. He was fully independent socially and mentally, but he still had some residual neurologic signs with right-sided homonymous hemianopia and visual agnosia. His HIV ribonucleic acid level was undetectable, and his CD4 count was 574 cells/mm(3). Although the median survival of patients with PML was poor before the antiretroviral therapy era, our patient, who is now aged 55 years, is still alive 12 years after the diagnosis. The diagnosis of PML and differential diagnosis of focal neurologic signs in HIV-positive patients are discussed in this case report.
一位 43 岁的白人同性恋艾滋病患者，于 1999 年 3 月出现视力模糊、性格改变和记忆力减退。他曾在两个月前因卡氏肺孢子虫肺炎入院治疗。入院时的磁共振成像扫描显示，双侧大脑半球和小脑区域存在多个白质病变，无肿块效应或周围水肿。脑脊液中的套式聚合酶链反应检测到 JC 病毒。这些发现诊断为进行性多灶性白质脑病（PML）。他的 CD4 计数为 34 个细胞/毫升，HIV 核糖核酸水平为 800789 拷贝/毫升。他接受了联合抗逆转录病毒治疗。他最后一次在 2011 年 10 月接受了检查。他在社会和心理上完全独立，但仍有一些残留的神经体征，包括右侧同向偏盲和视觉失认。他的 HIV 核糖核酸水平无法检测到，CD4 计数为 574 个细胞/毫米（3）。虽然在抗逆转录病毒治疗时代之前，PML 患者的中位生存期较差，但这位现年 55 岁的患者在诊断后 12 年仍存活。本病例报告讨论了 PML 的诊断和 HIV 阳性患者局灶性神经体征的鉴别诊断。
