Abstract Details

Title Double Trouble! Concomitant PML and Neurosyphilis Infection in Patient with Progressive Dysarthria with History of CVA and AIDS: A Case Report

Topic Infectious Disease

Presentation(s) P1 - Poster Session 1 (8:00 AM-9:00 AM)

Poster/Presentation
Number 3-012

Objective NA

Background Progressive multifocal leukoencephalopathy (PML) is a rare, progressive, and often fatal white matter disease caused by JC virus re-activation that occurs in immunocompromised patients, particularly those with AIDS. Neurosyphilis is the most common non-AIDS-defining central nervous system (CNS) infection, caused by untreated syphilis involving the CNS. Both diseases can present as focal neurologic deficits that may mimic ischemic stroke. We report a case of PML and neurosyphilis co-infection in a patient with prior ischemic stroke with known residual dysarthria, who presented to the hospital as a stroke code activation.

Design/Methods Case Report

Results 49-year-old male with past medical history of HIV/AIDs not on any antiretroviral therapy, and prior ischemic stroke with residual dysarthria presented to the emergency department for acute worsening of his dysarthria and new paresthesia. A stroke code was activated. A non-contrast CT head revealed subcortical edema in the posterior left frontal and left parietal temporal regions. Brain MRI demonstrated T2 FLAIR hyper-intensities within these regions consistent with white matter disease. Blood work showed a CD4+ count of 135 cells/uL, HIV viral load 43000 copies/mL, and serum RPR 1:32. Cerebrospinal fluid testing revealed JC virus level of 700 copies/ml and VDRL 1:1. Antiretroviral therapy with bictegravir/emtricitabine/tenofovir alafenamide (Biktarvy) was reinitiated along with a 14-day course of intravenous Penicillin G for neurosyphilis, resulting in improvement in mental status and dysarthria.

Conclusions This case describes PML and neurosyphilis co-infection presenting with stroke-like symptoms in a patient with a history of prior ischemic stroke and HIV/AIDS. Given the severity of PML, clinicians should consider this diagnosis in HIV-positive patients presenting with new neurological deficits, even in those with traditional stroke risk factors, to avoid delays in antiretroviral therapy initiation. Furthermore, confirmation of one CNS infection does not exclude others, a comprehensive CNS infectious workup is warranted in all HIV-positive patients with neurological manifestations.

Authors/Disclosures
Emma Streveler, MD PRESENTER	Dr. Streveler has nothing to disclose.
Ryan Crane, MD	Dr. Crane has nothing to disclose.
Hannah Bray, MD	Dr. Bray has nothing to disclose.
TaLawnda Bragg, MD	Dr. Bragg has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Corewell Health West.
Gordana Simeunovic, MD	Dr. Simeunovic has nothing to disclose.

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