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Case No. 613
2022-01-01~2022-01-31
출제자 : 서종현
Hit : 666
| Period | 2022-01-01~2022-01-31 |
|---|---|
| Diagnosis | PML-IRIS (progressive multifocal leukoencephalopathy immune reconstitution inflammatory syndrome) |
| Gender |
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| Age | 54 |
| Clinical information | 기저질환 없던 환자로 1주일 전부터 시작된 right facial palsy, dysarthria로 내원한 54세 여자환자이다. 내원하여 HIV가 진단되었고 3주후 MR에서 악화됨. 진단은? |
| Discussion | PML-IRIS (progressive multifocal leukoencephalopathy immune reconstitution inflammatory syndrome) HIV medication을 유지하면서 특별한 치료 하지 않고 3달 후 f/u에서 호전됨. 1. Introduction T-cell mediated encephalitis in setting of treated HIV Forced immune reconstitution exaggerated inflammatory response to infectious (or noninfectious) antigens with massive destruction of virus-infected cells CD8 cell infiltration in the leptomeninges, perivascular spaces, blood vessels and parenchyma is the pathologic hallmark Self limiting, mild symptoms ~ fulminating Response to corticosteroid therapy Diagnosis of exclusion Clinical deterioration of a newly treated HIV patient despite rising CD4 counts and diminishing viral loads 2. Radiologic findings Development of contrast enhancement (parenchymal, perivascular) Increased T2/FLAIR high SI, mass effect and diffusion restriction |
| Correct answer |
Correct Answer
Semi-Correct Answer |