Progressive multifocal leukoencephalopathy in HIV patient: A Rare Case Report.

Abstract

Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating disease caused by the JC virus, predominantly affecting immunocompromised individuals, including those with HIV/AIDS. This case report describes a 40-year-old HIV-positive female with a history of ART non-adherence, presenting with neurological deficits and diagnosed with PML. A 40-year-old Hindu female presented with multiple episodes of generalized tonic-clonic seizures over the past 10 days, blurring of vision, occasional diplopia in the right eye, fatigue, and right upper limb weakness with tingling sensation. She had been HIV-positive for 10 years and was on ART. On examination, she was conscious but confused. Neurological examination revealed decreased visual acuity in the right eye, mild confusion, attention and concentration difficulties, right upper extremity weakness (4/5 strength), positive Babinski sign on the right. MRI brain showed bilateral multifocal asymmetric white matter lesions. CD4 count was 80/mm³. She was treated with IV fosphenytoin, IV dexamethasone, and restarted on ART. Her condition improved, and she was discharged on oral levetiracetam with follow-up planned. This case underscores the importance of adherence to ART in preventing severe opportunistic infections like PML in HIV-positive patients.