Progressive Multifocal Leukoencephalopathy in AIDS

CASE PRESENTATION —John Williams, MD A 42-YEAR-OLD bisexual, white man presented complaining of progressive memory loss, confusion, and difficulty speaking for 1 week. The patient had been diagnosed with acquired immunodeficiency syndrome (AIDS) a year earlier when he developed cutaneous Kaposi's sarcoma. Three months before admission,Pneumocystispneumonia was diagnosed and treated. At that time, radiation therapy for his cutaneous Kaposi's lesions was performed. A month prior to admission, he was found to have Kaposi's sarcoma of the upper gastrointestinal tract. On admission he denied fever, sweats, headache, stiff neck, photophobia, seizures, or focal weakness. His medications were a combination product of sulfamethoxazale and trimethoprim and clotrimazole troches. Physical examination showed a temperature of 37°C; pulse rate, 82 beats per minute; blood pressure, 127/79 mm Hg; and respirations, 18/min. Notable physical findings included the cutaneous lesions of Kaposi's sarcoma, a 2/6 systolic ejection murmur at the left sternal border, and