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PML-IRIS Management — SCE Infectious Diseases MCQ

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HardCNS InfectionPML-IRIS ManagementSCE Infectious Diseases

A person with HIV-associated PML worsens 4 weeks after starting ART, developing seizures and new contrast enhancement around previously non-enhancing lesions. What is the most likely explanation?

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Correct answer: D — PML-associated immune reconstitution inflammatory syndrome with follow-up with review after review after cultures after review

The best answer is “PML-associated immune reconstitution inflammatory syndrome with follow-up with review after review after cultures after review”. Temporal relation to ART and new inflammatory enhancement support IRIS directed against JC-virus-infected tissue. “New CNS lymphoma proved by enhancement alone” does not match the decisive clinical feature or cited guidance. “A bacterial abscess without diffusion or microbiological evidence” does not match the decisive clinical feature or cited guidance. “Antiretroviral failure despite rapid immune recovery” does not match the decisive clinical feature or cited guidance. “Ordinary PML progression with no inflammatory component” does not match the decisive clinical feature or cited guidance.

Reference: BHIVA opportunistic-infection guidelines: https://bhiva.org/clinical-guideline/oi-guidelines/