PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY

AS A MANIFESTATION OF AIDS

Hadi Noor1, Husodoputro Henry Kusumo2, Supriatna Yana2

Resident1, Staff2 of Radiology Department, Faculty of Medicine, Universitas Gadjah Mada
ABSTRACT
BACKGROUND: Progressive multifocal leukoencephalopathy (PML) is a progressive
demyelinating disease that occurs in immunocompromised patients. Approximately 5% of the
AIDS patients have been reported to develop PML. The clinical presentation of PML is quite
variable because lesions may occur anywhere in the CNS white mater. The most common
findings are motor weakness, visual defects (e.g. visual blurring, diplopia), and
incoordination. The most frequently affected regions are the cerebral hemispheres, followed
by subtentorial lesions. Radiology examination such as CT scan may helpful for diagnostic
PML.
PRESENTATION CASE: A 32-year-old man human immunodeficiency virus (HIV)
positive presented to emergency room with severe headache, vomiting, and right-side
weakness. The past medical history revealed that the patient was known to be HIV positive
for 2 years, currently, he did not take ARV for 3 months. His absolute CD 4 count is 11
cell/L (normal 410-1590 cell/L). His history was also significant for opportunistic
infection, being diagnosed with pulmonary tuberculosis 1 year ago.
DISCUSSION: CT of the brain with and without media contrast demonstrate a large area of
low attenuation (approximately 20-22 HU) in the both hemisphere, without evidence of
midline shift, rim enhancement or contrast enhancement. It affects the white matter, and
sparing the cortex of the brain.
SUMMARY: We reported a rare case, Progressive multifocal leukoencephalopathy on 32
years old man with HIV-AIDS. CT is useful for detection of cerebral lesions in HIV-AIDS
patients. Imaging findings of the lesions in HIV-infected patients may overlap, and
differential diagnosis may be difficult; however, certain imaging characteristics and
localizations of lesions may helpful for the diagnosis.
KEYWORDS : AIDS, CNS, Progressive multifocal leukoencephalopathy