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Discussion Starter · #1 ·
A 46-year-old man with no past medical history comes to the ED complaining of an inability to move his left leg. He takes no medications or herbal compounds and denies having any allergies. The patient currently lives with a male companion, with whom he has been monogamous for 18 months. He denies any tobacco, ethanol, or intravenous drug use and has never had an HIV test. Neurologic examination reveals no cranial nerve deficits, and strength, sensation, and tone are normal in the upper extremities. The man has substantially increased tone in both legs, left more than right, and strength is 3/5 in the right hip flexors and knee extensors and 0/5 on the left. His reflexes are increased bilaterally, left more so than the right, and four beats of clonus are detected on the left. His toes are upgoing bilaterally. Laboratory tests are remarkable for a WBC count of 3000/mm3; a lumbar puncture is unremarkable. Follow-up HIV testing is positive, and his CD4+ count is 28/mm3. An MRI of the brain shows several nonenhancing white matter lesions; no mass effect is evident.
Which of the following is the likely mechanism for this patient’s symptoms?
(A) Demyelination of the central nervous system
(B) Infection with Candida albicans
(C) Infection with JC virus
(D) Infection with herpes simplex virus type 1
(E) Infection with Toxoplasma gondii
 

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Discussion Starter · #2 ·
PML

This seems to be Progressive Multifocal Leukonencephalopathy and it's caused by JC virus (Answer C)
 
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