Infectious diseases: progressive multifocal leukoencephalopathy: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Infectious diseases: progressive multifocal leukoencephalopathy

Sample item

A man with HIV and a CD4 count of 40 cells per microlitre has a subacute hemiparesis and cognitive decline. MRI shows asymmetric T2 hyperintense white matter lesions without mass effect or enhancement, and CSF PCR is positive for JC virus. What is the best treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Start or optimise antiretroviral therapy

Progressive multifocal leukoencephalopathy is caused by JC virus reactivation causing oligodendrocyte destruction. There is no specific antiviral, and restoring immunity with antiretroviral therapy is the treatment that improves survival.

Option by option

  • A. Pyrimethamine with sulfadiazine

    Pyrimethamine with sulfadiazine treats toxoplasmosis, which causes ring-enhancing lesions with mass effect.

  • B. Liposomal amphotericin B

    Amphotericin B treats cryptococcal meningitis and other fungal infections.

  • C. Start or optimise antiretroviral therapy (correct)

    Correct. Immune reconstitution is the only effective approach.

  • D. Intravenous aciclovir

    Aciclovir treats herpes simplex encephalitis, which is temporal and enhancing.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Start or optimise antiretroviral therapy. Progressive multifocal leukoencephalopathy is caused by JC virus reactivation causing oligodendrocyte destruction.

Why is "Pyrimethamine with sulfadiazine" not the answer?

Pyrimethamine with sulfadiazine treats toxoplasmosis, which causes ring-enhancing lesions with mass effect.

Why is "Liposomal amphotericin B" not the answer?

Amphotericin B treats cryptococcal meningitis and other fungal infections.

Why is "Intravenous aciclovir" not the answer?

Aciclovir treats herpes simplex encephalitis, which is temporal and enhancing.

What concept does this question test?

It tests Infectious diseases: progressive multifocal leukoencephalopathy in General Medicine. There is no specific antiviral, and restoring immunity with antiretroviral therapy is the treatment that improves survival.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Infectious diseases: progressive multifocal leukoencephalopathy?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.