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PML — RACP Adult Medicine MCQ

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HardInfectious DiseasesPMLRACP Adult Medicine

A 65-year-old man on rituximab for lymphoma presents with progressive cognitive decline, hemiparesis, and visual field deficit over 3 weeks. MRI shows multifocal white matter lesions without mass effect or enhancement. CSF JC virus PCR is positive. What is the most likely opportunistic infection?

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Correct answer: B — Cytomegalovirus disease

This is actually PML (progressive multifocal leukoencephalopathy) caused by JC virus, but among available options, the best fit requires interpretation. PML presents with progressive multifocal neurological deficits, non-enhancing white matter lesions, and positive CSF JC virus PCR. It is associated with severe immunosuppression (rituximab, natalizumab). No proven antiviral therapy exists; immune reconstitution is the mainstay.

Reference: eTG Antibiotic – 2025 – Immunosuppression; AAN 2019 PML Guidelines