Abstract Progressive multifocal leukoencephalopathy (PML) is a severe demyelinating disease caused by the JC virus, primarily affecting immunocompromised individuals, especially those with human immunodeficiency virus (HIV). Early recognition and differentiation from HIV encephalopathy are essential as the prognosis differs. We report the case of a 42-year-old female with HIV and poor antiretroviral therapy (ART) adherence, presenting with neurological symptoms including headache, seizures, and right-sided weakness. Magnetic resonance imaging findings were of asymmetrical white matter T2 and T2 fluid-attenuated inversion recovery hyperintensity with mass effect, without atrophy and contrast enhancement, leading to the consideration of PML. This case highlights the variability in PML presentations and emphasizes the importance of distinguishing it from HIV encephalopathy. The resolution of symptoms following appropriate treatment underscores the necessity of early diagnosis and tailored management strategies in HIV-positive patients.
Krishna et al. (Wed,) studied this question.