new_n_lost
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A 40-year-old HIV-positive man with a CD4 cell count of 25/mm3 complains of progressive memory loss, confusion, and incontinence. MRI reveals moderate brain atrophy. The patient subsequently dies of disseminated aspergillosis.
Autopsy confirms the presence of moderate cerebral atrophy. Histologically, there are multifocal lymphohistiocytic infiltrates with numerous microglial nodules and scattered multinucleated giant cells.
Which of the following conditions was most likely responsible for this patient's neurologic symptoms?
A. Aspergillosis
B. CMV encephalitis
C. HIV encephalitis
D. Mycobacterial infection
E. Vacuolar myelopathy
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| new_n_lost
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Guys Nobody Cmon 11 views u guys find it easy PPL CMON !!!!!!!!!!!!!!!!!!!
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| jazzblue
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C. HIV encephalitis
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| mytime
Kick my butt!
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D.
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| new_n_lost
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The correct answer is C.
Patients with AIDS develop a number of neurologic complications, including opportunistic infections, lymphomas, polyneuropathies, and a form of subacute encephalitis. HIV gains access to the CNS through incoming macrophages and may cause a subacute inflammation of the brain parenchyma known as HIV encephalitis. Typical clinical manifestations and histopathologic features of HIV encephalitis are mentioned in the clinical case. The presence of multinucleated giant cells should be emphasized since this is typical of HIV encephalitis. All the other histologic features can be seen in any other form of viral encephalitis.
Aspergillosis (choice A) is an opportunistic infection caused by Aspergillus species, a ubiquitous fungus found in the environment. Aspergillosis is frequent not only in AIDS, but in many immunocompromised patients. Aspergillus has a specific tropism for blood vessels, causing damage to vessel walls and producing hemorrhagic infarcts in the brain and other organs. The MRI and histopathologic findings rule out Aspergillus infection as the cause of this patient's neurologic condition.
CMV encephalitis (choice B) is a frequent opportunistic infection affecting AIDS patients. CMV's tropism for epithelial and ependymal cells explains why this virus is found in ependymal and periventricular locations. Typical cytomegalic cells, which contain large purple intranuclear inclusions and granular cytoplasmic inclusions, represent important clues to the diagnosis. The accompanying tissue reaction is similar to that of any viral infection of the brain: lymphocytic infiltration (perivascular cuffing), microglial nodules, and neuronophagia (degenerating neurons surrounded by lymphocytes).
Mycobacterial infections (choice D), including infections by Mycobacterium tuberculosis and Mycobacterium avium-intracellulare complex, frequently affect AIDS patients. Because of the AIDS epidemic and the emergence of multidrug resistance, the incidence of mycobacterial infections has been increasing in the U.S. Mycobacteria can cause a chronic meningoencephalitis involving the basal surface of the brain or a tuberculoma (a circumscribed lesion consisting of confluent caseating granulomas). Acid-fast bacilli can be demonstrated in these lesions.
Vacuolar myelopathy (choice E) is a noninfectious complication of obscure pathogenesis involving the spinal cord. It is very similar to subacute combined degeneration pathologically. Vacuolar myelopathy, like subacute combined degeneration, may be related to vitamin B12 deficiency. In this condition, ascending (sensory) tracts in the posterior columns and descending (pyramidal-motor) tracts in the lateral columns degenerate, leading to sensory loss, ataxia, and spastic paraplegia.
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| jaide
say wat!~
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i got c..only...i was late...
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| lq2006
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HIV encephalitis
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| SmokyWaters
Forum Elite
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yeah C....
slow AIDS dementia also ensues
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| drduck
Forum Guru
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i dont understand one thing from this Q.....
is it possible to have lymhocytosis....in a patient of AIDS....with...CD4+ count of 25/mm3...????
picture is most likely of AIDS....but plz help me out with this....
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| SmokyWaters
Forum Elite
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wheres lymphocytosis mentioned? 
I can see lymphohistiocytic infliterates...
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