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A 59-year-old right-handed homosexual male with no past medical history presented with 2 weeks history of headache and progressive aphasia. Patient was found to be HIV positive with HIV-1 RNA PCR at 283,000 copies/ml.
Axial Flair MRI of the Brain. Note the prominent lesion affecting the white matter in the left frontal and parietal areas. Some abnormalities are also seen in the splenium of the corpus callosum and contralateral white matter. Also note the absence of any mass effect. This condition is known as Progressive Multifocal Leukoencephalopathy which results from an opportunistic infection from the JC virus. This condition occurs in AIDS and other immunocompromised patients. It is recognized as a progressive, subacute process affecting the white matter without enhancement or mass effect on imaging studies. Subsequently, the patient had a lumbar puncture which showed a normal number of cells but with elevated protein at 83 mg/ml. JC DNA was detected by PCR and the patient was treated with HAART.
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