case_images: PMC9900419_01
case_images: Brain multi-sequential MRI . Multiplanar, multi-sequential MRI of the brain with and without contrast in images A, B, C, and D showing interval development of small T2 and FLAIR hyperintense signals noted in the left peri-insular region (C and D) and in the left medial temporal lobe (B).
case_images: cureus-0015-00000033473-i01.jpg
case_images: PMC9900419_01_cureus-0015-00000033473-i01.jpg
case_images: FIG1
case_images: His CT showed T2 and FLAIR hyperintense signal lesions in the bilateral periventricular and subcortical white matter of the frontal lobes, left frontoparietal lobe, left occipital lobe, and left thalamus (Figure 1); findings were consistent with PML with disease progression, and right frontal craniotomy was performed for biopsy.
case_images: Progressive multifocal leukoencephalopathy (PML). (A) Bizarre, pleomorphic multilobulated astrocytic nuclei in the background of histiocytes is a characteristic feature of PML (H&E, 20x). (B) Inclusion-bearing, enlarged nuclei in virally infected oligodendrocytes with a peripheral displacement of native nuclear chromatin (H&E, 40x). (C) SV40 viral protein immunohistochemistry demonstrates immunoreactivity in enlarged and small oligodendroglial nuclei (H&E, 20x). (D) Virally infected cells bind p53 and demonstrate nuclear immunoreactivity (H&E, 40x).
case_images: cureus-0015-00000033473-i02.jpg
case_images: PMC9900419_01_cureus-0015-00000033473-i02.jpg
case_images: FIG2