好色先生

好色先生

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Abstract Details

Progressive Multifocal Leukoencephalopathy in Acquired Immunodeficiency Syndrome Patients with High T-Helper Cell Count: Report of Two Cases
Infections/AIDS/Prion Disease
P06 - (-)
179
BACKGROUND: PML is a demyelinating disease caused by JC virus infection and typically seen in AIDS when CD4 count decreases less than 200 cells/mm3. It usually presents with focal neurological symptoms and brain MRI shows multiple nonenhancing white matter lesions that have predilection to the parietal or occipital lobes.
DESIGN/METHODS: We performed retrospective chart review of two PML cases with elevated CD4 count.
RESULTS: Case 1 was a 46 year-old man with AIDS (CD4: 420 cells/mm3, viral load <48) who was well maintained on Highly Active Antiretroviral Therapy (HAART). He presented with a three-month history of generalized weakness, dysarthria and dysphagia. Neurological examination revealed tongue fibrillations, diffuse hyperreflexia, and quadriparesis. Brain MRI showed bilateral T2 hyperintensities involving the corticospinal tracts from the internal capsule level to the brain stem. Cerebrospinal fluid (CSF) analysis showed elevated protein (110 mg/dl) and positive JCV DNA PCR. He progressively worsened over few weeks and died from aspiration pneumonia. Autopsy showed diffuse cerebral hemispheres and brain stem demyelination with classical pleomorphic multinucleated astrocytes and ground glass appearance of infected oligodendrocyte nuclei. Case 2 was a 50 year-old female with AIDS (CD4: 513 cells/mm3, viral load: 284000). She presented with a three-week history of gait instability. Neurological examination revealed dysarthria, impaired ocular smooth pursuits, bilateral limb dysmetria and titubation. Brain MRI revealed nonenhancing T2 hyperintensity in the brachium pontis and cerebellar hemispheres. CSF analysis showed lymphocytic pleocytosis, elevated protein (WBC 97, protein 94.6 mg/dl) and positive JCV DNA PCR. She was stable at three month follow up after starting HAART.
CONCLUSIONS: PML may have variable clinical and radiologic presentations among HIV patients. Elevated CD4 count may contribute to this variation.
Authors/Disclosures
Yousef Hannawi, MD (Ohio State University)
PRESENTER 		The institution of Dr. Hannawi has received research support from NIH.
Shirine Majmudar, MD No disclosure on file
Jharna N. Shah, MD (Baptist Medical Center) No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
Joseph S. Kass, MD, JD, FAAN (Baylor College of Medicine) Dr. Kass has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for 好色先生 . Dr. Kass has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier. Dr. Kass has received personal compensation in the range of $100,000-$499,999 for serving as an Expert Witness for Multiple Law Firms . Dr. Kass has received publishing royalties from a publication relating to health care.