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  #1  
Old 10-06-2012
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Arrow Billy Step 1 Questions #13

MICROBIOLOGY :

13 A homeless 37-year-old woman with HIV infection comes to the clinic with a 4-week history of worsening hemiparesis, visual field deficits, and cognitive impairment. She has gone 2 years without antiretroviral therapy. The patient’s CD4+ cell count is 22/mm3. MRI shows several hyperintensities on T2-weighted images that do not enhance with contrast and are not surrounded by edema. A lumbar puncture shows a normal opening pressure, and cerebrospinal fluid analysis shows a mildly elevated protein level and the presence of myelin basic protein, with a mild mononuclear pleocytosis.
Which of the following entities is most likely responsible for this patient’s clinical picture?

(A) Cytomegalovirus encephalitis
(B) JC virus
(C) Primary central nervous system lymphoma
(D) Toxoplasmosis
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  #2  
Old 10-09-2012
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Primary CNS lymphoma?
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  #3  
Old 10-09-2012
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JC VIRUS =PML
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Old 10-09-2012
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Quote:
" several hyperintensities on T2-weighted images that do not enhance with contrast "
i think this is whitening of gray matter so : progressive multifocal leukoencephalopathy (PML) JC Virus
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Old 10-09-2012
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B) JC virus

"cerebrospinal fluid analysis shows a mildly elevated protein level and the presence of myelin basic protein"-----destruction of myelin (oligodendrocytes)increases MBP---PML
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  #6  
Old 10-09-2012
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Yes B is correct.
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