Double Trouble! Concomitant PML and Neurosyphilis Infection in Patient with Progressive Dysarthria with History of CVA and AIDS: A Case Report

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Authors

• Emma Streveler, Neurology Resident - Corewell Health West
• Ryan Crane, Internal Medicine Resident - Corewell Health West
• Hannah Bray, Infectious Disease Fellow - Corewell Health West
• Talawnda Bragg, Hospitalists - Corewell Health West
• Gordana Simeunovic, Infectious Disease - Corewell Health West

Description

Progressive multifocal leukoencephalopathy (PML) is a rare, progressive, and often fatal, white matter disease caused by JC virus re-activation that occurs in immunocompromised patients, particularly those with AIDS. Neurosyphilis is the most common non-AIDS-defining central nervous system (CNS) infection caused by untreated syphilis involving the CNS. Both diseases can present as focal neurologic deficits that may mimic ischemic stroke, making it difficult to identify upon presentation, even in patients who are immunocomprised. We report a case of PML and neurosyphilis coinfection in a patient with prior ischemic stroke with known residual dysarthria, who presented to the hospital as a stroke code activation.

49-year-old male with past medical history of HIV/AIDs not on any antiretroviral therapy, and prior ischemic stroke with residual dysarthria presented to the emergency department for acute worsening of his dysarthria and new paresthesia. A stroke code was activated. A non-contrast CT head revealed subcortical edema in the posterior left frontal and left parietal temporal regions. Brain MRI demonstrated T2 FLAIR hyperintensities within these regions consistent with white matter disease. Blood work showed a CD4+ count of 135 cells/uL, viral load 43000 copies/mL, and serum RPR 1:32. Cerebrospinal fluid testing revealed JC virus level of 700 copies/ml and VDRL 1:1.

Given the rarity of PML, clinicians should consider this diagnosis in HIV-positive patients presenting with new neurological deficits, even in those with traditional stroke risk factors, to avoid delays in antiretroviral therapy initiation. Furthermore, confirmation of one CNS infection does not exclude others, a comprehensive CNS infectious workup is warranted in all HIV-positive patients with neurological manifestations.

Publication Date

5-8-2026

Disciplines

Neurology

Recommended Citation

Streveler E, Crane R, Bray H, Bragg T, Simeunovic G. Double trouble! Concomitant PML and neurosyphilis infection in patient with progressive dysarthria with history of CVA and AIDS: A case report. Presented at: Research Day Corewell Health West; 2026 May 8; Grand Rapids, MI.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 1904