A 37-year-old man who is HIV-1-positive has had increasing memory problems for the past year. He is depressed.
During the past 3 months, he has had increasing problems with motor function and is now unable to stand or walk. For the
past 3 days, he has had fever, cough, and dyspnea. A bronchoalveolar lavage shows cysts of Pneumocystis jiroveci. MRI
of the brain shows diffuse cerebral atrophy; no focal lesions are identified. On microscopic examination of the brain, which
of the following findings is most likely to be present?
A. Plaques of demyelination in periventricular white matter B. Neocortical senile plaques and neurofibrillary tangles C. Multiple lacunar infarcts in basal ganglia D. Spongiform change involving cerebellum and neocortex E. White matter microglial nodules with multinucleate cells
White matter microglial nodules with multinucleate cells-(e) this patient has aids dementia complex late in the course of hiv infection. hiv-1 produces an encephalitis that is
characterized by a collection of reactive microglial cells (microglial nodules). hiv-1-infected mononuclear cells, particularly
macrophages, can fuse to form multinucleate cells, which are seen in association with microglial nodules. plaques of
demyelination are typical of multiple sclerosis. senile plaques and tangles are typical of alzheimer disease and are unlikely
to manifest at this patients age. lacunar infarcts are small, cavitary infarcts that result from arteriolosclerosis of the deep
penetrating arteries and arterioles. such arteriolar lesions occur in individuals with long-standing hypertension and are
unlikely to be found in a 37-year-old man. spongiform change suggests creutzfeldt-jakob disease, a rapidly progressive
dementia unrelated to hiv infection.
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