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USMLE · Question #594

A 40-year-old male is brought to the emergency department due to progressive memory loss, confusion, and urinary incontinence. Laboratory studies reveal a CD4 cell count of 25/mmֲ3. A MRI reveals…

The correct answer is B. HIV encephalitis. Patients with AIDS and a CD4 cell count of 25/mmֲ³ can develop many complications, including opportunistic infections, lymphomas, polyneuropathies, and subacute encephalitis. HIV gains access to the CNS through incoming macrophages and may cause a subacute inflammation of the…

Abnormal Processes

Question

A 40-year-old male is brought to the emergency department due to progressive memory loss, confusion, and urinary incontinence. Laboratory studies reveal a CD4 cell count of 25/mmֲ3. A MRI reveals moderate brain atrophy. Although the patient is admitted for treatment he eventually dies of disseminated aspergillosis. Microscopic examination of an autopsy specimen from his brain shows multifocal lymphohistiocytic infiltrates with numerous microglial nodules and scattered multinucleated giant cells. His histologic and MRI findings were most likely caused by

Options

  • Aaspergillosis
  • BHIV encephalitis
  • Cmycobacterial infection
  • Dprogressive multifocal leukoencephalopathy
  • Evacuolar myelopathy

How the community answered

(43 responses)
  • A
    2% (1)
  • B
    81% (35)
  • C
    5% (2)
  • D
    2% (1)
  • E
    9% (4)

Explanation

Patients with AIDS and a CD4 cell count of 25/mmֲ³ can develop many complications, including opportunistic infections, lymphomas, polyneuropathies, and 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, which typically occurs in AIDS patients with CD4 counts less than 200/mmֲ³. The presence of multinucleated giant cells is typical of HIV

Topics

#HIV encephalitis#multinucleated giant cells#microglial nodules#AIDS dementia

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