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Toxo/PML-which is it?
Mar 11, 2002

My partner was test positive for HIV 2 1/2 months ago. He had a T-Cell count of 43 and virus load in the thousands. This was discovered when a tremor started in his right arm - now the whole right side of his body is numb and he has trouble walking. He has had 2 MRI's - first diagnois was Toxo but he has been on the treatment since January and no improvement - thought the second MRI showed that the lesion was getting smaller. He is having another MRI next week - his T-Count is now 75 (the doctor told him that this is the fast rise he has seen in a patient) and his viral load below 400. I am scared that this is not toxo but PML. His right leg has severe muscle contractions - then he can walk completely normal for awhile - then another contraction. What if they want to do a biopsy - would you recommend it? This site has been wonderfully informative for us. Advice? Thank you.

Response from Dr. Feinberg

It can be hard to diagnose infections in the brain. If your partner's condition is getting worse, there are 2 possibilities: (1) Toxo is the wrong diagnosis, or (2) he is developing an "immune reconstitution syndrome" to the toxo and is haing clinical worsening because of that. If it's toxo, it will continue to shrink on CT or MRI scans. PML has a characteristic look on scans, especially MRI scans, that can be helpful in making a diagnosis of PML. Sometimes the only way to get at an accurate diagnosis is to do a brain biopsy, but even a biopsy can fail to make a diagnosis and carries with it all the risks associated with neurosurgey. I am not trying to argue you out of getting a biopsy, just trying to make the picture as realistic as I can. It may be very helpful.


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