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A 28-year-old man with acquired immune deficiency syndrome (AIDS) is hospitalized for the treatment of Pneumocystosis carinii pneumonia and esophageal candidiasis. He was diagnosed with AIDS fourteen months ago. His current medications include zidovudine, lamivudine and indinavir. In the hospital, he is being treated with trimethoprim - sulfamethoxazole (Bactrim) and intravenous fluconazole (Diflucan). There is an apparent symptomatic improvement with therapy. On his fourth day in the hospital, he complains of decreased vision on the right side, and weakness and a tingling sensation in the right upper and lower extremities. Physical examination reveals visual field defects in both eyes, but the pupillary reflexes are intact. The right upper and lower extremities exhibit exaggerated deep tendon reflexes and diminished sensations of touch and motor strength. MRI of the brain reveals non-enhancing demyelinating lesions in the parietal-occipital region of the left cerebral hemisphere with no mass effect. Which of the following is the most likely diagnosis?
c A. Progressive multifocal leukoencephalopathy
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A. Progressive multifocal leukoencephalopathy
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Progressive multifocal leukoencephalopathy
Toxoplasmosis. CNS lymphoma
Brain abscess
HIV encephalopathy
Posts: 3,675,934
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A 28-year-old man with acquired immune deficiency syndrome (AIDS) is hospitalized for the treatment of Pneumocystosis carinii pneumonia and esophageal candidiasis. He was diagnosed with AIDS fourteen months ago. His current medications include zidovudine, lamivudine and indinavir. In the hospital, he is being treated with trimethoprim - sulfamethoxazole (Bactrim) and intravenous fluconazole (Diflucan). There is an apparent symptomatic improvement with therapy. On his fourth day in the hospital, he complains of decreased vision on the right side, and weakness and a tingling sensation in the right upper and lower extremities. Physical examination reveals visual field defects in both eyes, but the pupillary reflexes are intact. The right upper and lower extremities exhibit exaggerated deep tendon reflexes and diminished sensations of touch and motor strength. MRI of the brain reveals non-enhancing demyelinating lesions in the parietal-occipital region of the left cerebral hemisphere with no mass effect. Which of the following is the most likely diagnosis?
c A. Progressive multifocal leukoencephalopathy
B. Toxoplasmosis
¢ C. CNS lymphoma
¢ D. Brain abscess
c E. HIV encephalopathy
