PML in a patient with idiopathic CD4 lymphopenia

My last post prompted the inimitable Dr. Murat Gokden to write to me about an interesting case he published in 2015 of a 33-year-old man who with idiopathic CD4 lymphopenia (ICL) who was ultimately diagnosed with progressive multifocal leukoencephalopathy (PML).

Image from Dr. Gikden's paper: A and B are MRI FLAIR images showing hyperintense areas with gyral swelling and sulcal effacement (curved arrows). Image C depicts MR spectroscopy with abnormally elevated choline peak. Image D shows multifocal punctate enhancement in white matter.

Murat Gokden, MD