515 - Progressive Multifocal Leukoencephalopathy/HIV Encephalitis Presenting as Tardive Dyskinesia: a Case Report

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

BW

Brian Win, BS

Medical Student
Touro University Nevada
Henderson, Nevada, United States
SD

Saiteja Damineni, DO

PGY-2 PM&R Resident
Rochester Regional Health
Rochester, New York, United States

Co-Author(s)

DC

Daniel Caylor, DO

Resident Physician
Rochester Regional Health
Rochester, New York, United States
CR

Cecilia Ransom, MD

Adjunct Clinical Assistant Professor
LECOM
Rochester, New York, United States

Submitter(s)

BW

Brian Win, BS

Touro University Nevada
Henderson, Nevada, United States

Case Diagnosis: Progressive Multifocal Leukoencephalopathy (PML) / HIV Encephalitis

Case Description: PML, a demyelinating disease caused by JC virus reactivation, and HIV encephalopathy are both AIDS-defining conditions that may present with cognitive and motor dysfunction in immunocompromised patients. This is a case of a 47 year old African American female with medical history significant for congenital hip dysplasia who presents to the acute rehabilitation unit with tardive dyskinesia-like symptoms including involuntary facial movements, dyskinesia of the extremities.

Discussions: Patient was discharged from acute hospital where she presented with encephalopathy and fever to 103.2°F, prompting workup for autoimmune encephalitis. Empiric acyclovir, ceftriaxone, and vancomycin for possible meningitis/encephalitis were started but discontinued shortly after negative studies. Initial workup, including EEG with generalized slowing, CSF, and spine MRI was unrevealing. MRI brain was limited due to motion artifact. During acute rehab she developed worsening encephalopathy, confusion, and dyskinesia requiring transfer. Further testing revealed HIV with viral load 139,000 and CD4 of 6. MRI was concerning for PML versus chronic HIV encephalopathy. Repeat CSF showed HIV VL 77,900. She was CMV IgG positive with low-level viremia but no retinitis, and JCV antibody positive, indicating prior exposure. She was started on HAART and PJP prophylaxis with significant improvement, able to engage in therapies during acute rehab, and ultimately discharged home with HIV clinic follow-up.

Conclusions: This case highlights the importance of considering HIV/AIDS in the differential of encephalopathy and movement disorders, especially in patients without prior medical history suggestive of CNS opportunistic infection.