BACKGROUND: Progressive Multifocal Leukoencephalopathy (PML) is a demyelinating opportunistic infection of the CNS by the JC polyoma virus. It is characterized clinically by progressive neurologic deterioration and can be the presenting manifestation of HIV/AIDS.
CASE REPORT(S). A 36-year old white male, with no past medical or ocular history, presented complaining of losing his place when reading and a ‘spot’ in his vision for the past six months. He reported an associated left-sided progressive headache, which began two months prior. VA’s measured 20/20 OD, OS. Pupil testing was normal. Goldmann visual field testing (GVF) revealed small, congruous, absolute paracentral scotomas OD, OS. Examinations of the anterior and posterior segment were unremarkable. MRI scan of the brain revealed an area of abnormal signal intensity of the left occipital lobe with white matter involvement. There was no associated edema or mass effect. Neurological testing demonstrated mental status changes, fluent agraphia, with plantars downgoing bilaterally. Hematology confirmed a positive HIV serology and CD4 count of 170 cells/ml. The patient was started on AIDS therapy. Follow up care observed the progression of a right homonymous hemianopia, decline in mental status and decreased sensory and motor skills. This resulted in declining confidence during activities of daily living and cessation of independent travel. Spectacles fitted with 20p.d. base right Fresnell prisms in sector form demonstrated improved confidence and quality of life for this patient.
CONCLUSIONS. This presentation will follow the progression of visual field loss and neurological deterioration as a result of HIV infection in a previously undiagnosed patient. Serial GVF and MRI studies will be presented along with medical and optometric management.