CONTRAST-ENHANCING PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY - RADIOLOGICAL AND PATHOLOGICAL CORRELATIONS - CASE-REPORT

OBJECTIVE AND IMPORTANCE: Progressive multifocal leukoencephalopathy ( PML), a demyelinating disease caused by the JC papovavirus, is an oppo rtunistic infection afflicting patients with impaired cellular immunit y. Although initially described in patients with hematological maligna ncies, PML has become associated with several other immunocompromised states, particularly human immunodeficiency virus (HIV) infection. The re are numerous central nervous system manifestations in patients with acquired immunodeficiency syndrome. A major characteristic that disti nguishes PML from other more common lesions, such as toxoplasmosis or non-Hodgkin's lymphoma, is the lack of contrast enhancement. We descri be a case of PML that exhibits contrast enhancement, and we conclude t hat the diagnosis of PML must be considered in patients with HIV who h ave contrast-enhancing lesions. CLINICAL PRESENTATION: A 40-year-old w oman presented with progressive hemiparesis, blurred vision, and ataxi a. Magnetic resonance imaging revealed a contrast-enhancing lesion inv olving the left middle cerebellar peduncle, causing mild compression o f the fourth ventricle. INTERVENTION: The patient underwent a stereota ctic serial biopsy with the presumptive diagnosis of moderate- to high -grade glioma. Histological examination of the biopsy specimen reveale d early PML. Subsequently, a test for HIV was obtained and the results were positive. CONCLUSION: We have reported another atypical radiogra phic characteristic of PML associated with HIV. We conclude that PML l esions can enhance after the administration of gadolinium. Therefore, the diagnosis of PML must be entertained in patients whose test result s were positive for HIV with contrast-enhancing lesions and that a ste reotactic serial biopsy may be necessary to provide a definitive diagn osis.