A 44-year-old Hispanic male was brought in with the chief complaints of progressive neurologic deterioration such as paranoid behavior, complete loss of memory, generalized weakness, and urine incontinence for 2 months. The patient was an active smoker, a heavy drinker, an intravenous drug abuser, and was sexually active. He used to work in a restaurant 2 months ago with completely normal mental status. His physical examination showed low-grade fevers and gait ataxia; his level of consciousness was always proper, but the content was altered. Laboratory testing showed he was human immunodeficiency virus (HIV) positive (CD4 count- 348 cells/mm3) with normal complete blood count (white blood cell count 5.4 M/muL, hemoglobin 12 g/dL, and platelet count 176x109/L). His kidney function was persistently normal; urinalysis was normal as well. Lumbar puncture was done and cerebrospinal fluid showed normal white blood cell count with normal glucose and protein levels. The entire HIV-related opportunistic infections including herpes simplex, cytomegalovirus, toxoplasma, tuberculosis, progressive multifocal leukoencephalopathy, and John Cunningham virus were negative, except EBV, which was followed as shown in Table 1. Imaging studies including magnetic resonance imaging and computed tomography scans were performed, which showed lucencies at different levels of brain and around the ventricles (Figure 1).
This patient was started on antiviral therapy acyclovir 10 mg/kg and his symptoms started resolving day by day. Patient was followed in infectious disease clinic and after 6 months, he was again completely functional.
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