Contrast-enhancing Progressive Multifocal Leukoencephalopathy: Radiological and Pathological Correlations: Case Report

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Abstract
Progressive multifocal leukoencephalopathy (PML), a demyelinating disease caused by the )C papovavirus, is an opportunistic infection afflicting patients with impaired cellular immunity. Although initially described in patients with hematological malignancies, PML has become associated with several other immunocompromised states, particularly human immunodeficiency virus (HIV) infection. There are numerous central nervous system manifestations in patients with acquired immunodeficiency syndrome. A major characteristic that distinguishes PML from other more common lesions, such as toxoplasmosis or non-Hodgkin's lymphoma, is the lack of contrast enhancement. We describe a case of PML that exhibits contrast enhancement, and we conclude that the diagnosis of PML must be considered in patients with HIV who have contrast-enhancing lesions. A 40-year-old woman presented with progressive hemiparesis, blurred vision, and ataxia. Magnetic resonance imaging revealed a contrast-enhancing lesion involving the left middle cerebellar peduncle, causing mild compression of the fourth ventricle. The patient underwent a stereotactic serial biopsy with the presumptive diagnosis of moderate- to high-grade glioma. Histological examination of the biopsy specimen revealed early PML. Subsequently, a test for HIV was obtained and the results were positive. We have reported another atypical radiographic characterise of PML associated with HIV. We conclude that PML lesions can enhance the administration of gadolinium. Therefore, the diagnosis of PML must entertained in patients whose test results were positive for HIV with contrast- chancing lesions and that a stereotactic serial biopsy may be necessary to Provide a definitive diagnosis.