A case of progressive multifocal leucoencephalopathy and cerebral toxoplasmosis in an HIV-infected patient

Abstract

Progressive multifocal leukoencephalopathy (PML) is an opportunistic infection of the central nervous system (CNS) caused by the reactivation of John Cunningham polyomavirus (JCV). Most often, this disease is observed in patients with severe immune suppression, such as those with AIDS. Cerebral toxoplasmosis results from the reactivation of a latent infection with Toxoplasma gondii, an intracellular parasite. This parasitosis is relatively rare in the United States, while in some regions of Europe the seropositive population is over 90%. Similarly, to PML, cerebral toxoplasmosis develops in stages of advanced immune defi ciency. Both of these opportunistic infections of the central nervous system can cause severe neurological symptoms, and their simultaneous presentation can represent a diagnostic and therapeutic problem. We present a case of a 59-year-old patient with a newly diagnosed HIV infection with manifestations of epilepsy and progressive cognitive impairment. The patient was diagnosed initially with cerebral toxoplasmosis and subsequently with progressive multifocal leukoencephalopathy.