Progressive multifocal leukoence-phalopathy presenting as homonymous hemianopia in a patient with acquired immunodeficiency syndrome
A 50-year-old lady was referred for retinal evaluation to rule out AIDS-related retinal or ocular disorders. She complained of some disturbance in vision in both eyes since 15 days. She was a known case of AIDS since 10 years on treatment with Tab. Viraday (combination of Tenofovir, Emtricitabine and Efavirine) 1 per day. Her CD4 count was 128 cells/mm. She had no other neurological symptoms. Her vision in both eyes was 20/40, N/6. Anterior segment examination revealed no abnormality. There were no signs of uveitis. There was no relative afferent papillary defect (RAPD). Her intraocular pressure was 12 mm Hg in both eyes. Fundus examination showed no abnormality. There was no cytomegalovirus (CMV) retinitis. Optic nerves appeared normal.\nA visual field examination using 30-2 program on Oculus – Center Field perimeter was performed to rule out lesions along the visual pathway, as clinical examination could not explain the visual loss or the symptoms. It showed good reliability in both eyes and a left homonymous hemianopia [Figs. and ]. Magnetic Resonance Imaging (MRI) of brain was done to determine the cause of homonymous hemianopia, such as infarct/bleed or space-occupying lesion. MRI scan showed irregular white matter hyperintensity in the right occipital lobe and a hyperintense lesion in the left frontoparietal region in the subcortical and periventricular white matter []. It also showed irregular white matter hyperintensity and a large area of increased T2-weighted and decreased T1-weighted signal in the left frontal lobe posteriorly involving the subcortical white matter and extending into the centrum semiovale and corona radiata, without enhancement or mass effect. A radio diagnosis of PML was made.\nShe was referred to a neurologist for evaluation. Her neurological evaluation showed no abnormality. A cerebrospinal fluid (CSF) tap was advised for Polymerase Chain Reaction (PCR) evaluation for JC virus. But the patient refused to undergo the same.