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Differential Diagnosis for a 45-year-old HIV Patient with Sudden Weakness

Single Most Likely Diagnosis

  • Progressive Multifocal Leukoencephalopathy (PML): Given the patient's HIV status with a CD4 count of 200, indicating a compromised immune system, PML is a strong consideration. It's a rare and often fatal viral disease caused by the JC virus that affects the brain and leads to symptoms like weakness, vision loss, and cognitive decline.

Other Likely Diagnoses

  • Toxoplasmosis: This is a common opportunistic infection in HIV patients with low CD4 counts. It can cause focal neurological deficits, including weakness, due to the formation of brain abscesses.
  • CNS Lymphoma: Primary central nervous system lymphoma is more common in immunocompromised patients, such as those with HIV/AIDS. It can present with a variety of neurological symptoms, including focal weakness.
  • Stroke: While less likely given the lack of other risk factors mentioned, stroke (either ischemic or hemorrhagic) can occur in HIV patients and presents with sudden weakness.

Do Not Miss Diagnoses

  • Spinal Cord Compression: This is a medical emergency that can present with sudden onset of weakness, especially if the compression is at a high level of the spinal cord. Causes can include metastatic disease, abscess, or hematoma.
  • Meningitis: Although the patient does not have neck rigidity, meningitis (especially chronic meningitis) should be considered, as it can present subtly in immunocompromised patients.
  • CNS Tuberculosis: Tuberculosis can affect the central nervous system in various forms, including meningitis or tuberculoma, which can cause focal neurological deficits.

Rare Diagnoses

  • Subacute Sclerosing Panencephalitis (SSPE): A rare chronic, progressive encephalitis that affects primarily children and young adults, caused by a persistent infection with a defective measles virus.
  • Cytomegalovirus (CMV) Encephalitis: CMV can cause a variety of neurological manifestations in immunocompromised patients, including encephalitis, which might present with weakness among other symptoms.

Each of these diagnoses requires careful consideration of the patient's immune status, clinical presentation, and appropriate diagnostic testing for confirmation.

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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