A 29-year-old woman with multiple sclerosis on natalizumab therapy presents with acute severe headache, fever (38.9°C), and confusion. Vital signs show BP 118/76, HR 102, RR 18, SpO2 98% on room air. CSF analysis reveals lymphocytic pleocytosis (180 cells/μL) with low glucose (28 mg/dL) and normal protein. Brain MRI demonstrates multifocal white matter lesions with enhancement. She denies focal neurologic deficits. Which of the following is the most likely diagnosis?
- A)Bacterial meningitis
- B)Viral encephalitis
- C)MS disease exacerbation
- D)Progressive multifocal leukoencephalopathyGABARITO
- E)Demyelinating leukoencephalitis
Explicação
Progressive multifocal leukoencephalopathy (PML) is caused by JC virus and occurs in immunosuppressed patients, including those on natalizumab (which blocks VLA-4 and increases PML risk). Multifocal white matter lesions with CNS inflammation and fever distingu... Ver explicação completa e trilha adaptativa →