Dole SS* and Pujari SS
Department of Neurology, Deenanath Mangeshkar Hospital and Research Centre, IndiaFulltext PDF
Introduction: Progressive Multifocal Leukoencephalopathy (PML), caused by John Cunningham (JC) virus, affects up to 2% to 7% of HIV positive patients. It is postulated to be a reactivation of JC virus in a severely immunocompromised state, to manifest as a multifocal inflammatory white matter disease of the brain, commonest in supratentorial region. We present a case of subacute ataxia and bulbar weakness in an undiagnosed HIV patient, mimicking a lateral medullary infarct. Case Details: A 57 year old patient, not previously undiagnosed to have HIV infection, presented with slurring of speech and imbalance, 3 weeks after COVID-19 pneumonitis. MRI brain showed diffusion restriction with corresponding FLAIR hyperintensities in right lateral medulla. However, patient had progressive worsening of dysarthria and sensorium, warranting us to dig deeper and unmask HIV disease and a low CD4 cell count, thus helping us clinching the diagnosis of infratentorial presentation of PML. Conclusion: Isolated medullary involvement in PML is an even rarer presentation of this rare disease seen in immunocompromised individuals.
Dole SS, Pujari SS. An Interesting Case of Infratentorial PML Mimicking Lateral Medullary Infarct. Clin Case Rep Int. 2022; 6: 1400.