A 30-year-old pregnant woman from Tanzania at 32 weeks' gestation presents with headache, blurred vision, and confusion. She is HIV-positive with a CD...

Question

A 30-year-old pregnant woman from Tanzania at 32 weeks' gestation presents with headache, blurred vision, and confusion. She is HIV-positive with a CD4 count of 20 cells/µL. MRI brain shows asymmetric non-enhancing white matter lesions. JC virus PCR in CSF is positive. What is the prognosis and treatment?

Accepted Answer

Progressive multifocal leukoencephalopathy (PML) caused by JC virus; there is no specific antiviral, and the only treatment is immune reconstitution through ART, which carries risk of PML-IRIS

Answer

The condition is curable with ganciclovir

Answer

Cerebral toxoplasmosis; treat with sulfadiazine and pyrimethamine

Answer

HSV encephalitis; treat with IV aciclovir

Answer

CNS lymphoma; refer for chemotherapy

uk-dtmh MCQ (SBA): PML in Pregnancy with HIV