Human immunodeficiency virus-related progressive multifocal leukoencephalopathy with a CD4+ of 444 per mm3: a case report.

A 47-year-old homosexual man with human immunodeficiency virus infection and CD4+ cell count of 444 per mm3, and with a viral load of 95,720 copies per mL, developed a rapidly progressive cerebellar lesion one month after undergoing coronary artery bypass graft. Diagnostic data were unremarkable with the exception of the magnetic resonance imaging that revealed multiple subcortical and cerebellar lesions consistent with a demyelinating process. The patient died within two months. Postmortem examination of the cerebellum revealed acute phase progressive multifocal leukoencephalopathy. This case demonstrates that multifocal leukoencephalopathy must be considered in HIV+ patients in the setting of neurologic deterioration with radiographic evidence of demyelination regardless of CD4+ count.