12/09/2004 Case 2: HIV encephalitis

Clinical History:

A 50 year old woman presented with chorea of the face, head, and all extremities and cognitive impairment. Her clinical problems had begun at least 4 years earlier and she had gone downhill rapidly over the last year. CSF 14-3-3 protein was positive. Genetic tests for Huntington's Disease, HDL-2, and DRPLA (DentatoRubroPallidoLuysian Atrophy, remember?) were all negative, however. She had a gammopathy of unknown significance, had hospital admissions for fever of unknown origin, and secondary to urinary tract infections.

Diagnostic Notes:

The autopsy slide of brain showed perivascular myelin rarefaction with an infiltrate of mononuclear inflammatory cells together with small multinucleated giant cells. The appearance was typical for HIV encephalitis. Apparently this diagnosis was so doubted by the clinicians, who had not suspected AIDS, that Dr Chin did HIV p245 protein immunostains, which were nicely positive. It subsequently was learned that antemortem studies had also shown that she had lymphadenopathy and pneumonias. Epidemiological investigation disclosed that her first husband, who had been known to have died of "lymphoma", died of AIDS-related lymphoma.

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