A 31-year-old woman with multiple sclerosis on natalizumab for 18 months presents with progressive cognitive decline, right-sided weakness, and visual field defect. Vital signs: BP 128/82, HR 88, RR 16, Temp 37°C, SpO2 98%. Brain MRI reveals multifocal white matter lesions without gadolinium enhancement. CSF JC virus PCR is positive; oligoclonal bands are negative. She denies fever and has no recent infections. Which diagnosis best explains these findings?
- A)Progressive multifocal leukoencephalopathyGABARITO
- B)MS disease progression
- C)Natalizumab-associated posterior reversible encephalopathy syndrome
- D)Acute hemorrhagic encephalitis
- E)CNS toxoplasmosis
Explicação
Progressive multifocal leukoencephalopathy (PML) is caused by JC virus reactivation in immunocompromised patients. Natalizumab increases PML risk by suppressing immune function. Positive JC virus PCR in CSF is diagnostic. Non-enhancing white matter lesions wit... Ver explicação completa e trilha adaptativa →