• 1

    Berger J: The clinical features of PML. Cleveland Clinic J Med 78: S8S12, 2011.

  • 2

    Simpson, D: The clinical features of PML. Cleveland Clinic J Med 78: S2427, 2011.

  • 3

    Tavazzi E, White MK, Khalili K, et al: Progressive multifocal leukoencephalopathy: clinical and molecular aspects. Rev Med Virol 22: 18, 2012.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 4

    Viscidi RP, Khanna N, Tan CS, et al: JC virus antibody and viremia as predictors of progressive multifocal leukoencephalopathy in Human Immunodeficiency Virus-1-infected individuals. Clin Infect Dis 53: 711, 2011.

    • Crossref
    • PubMed
    • Web of Science
    • Search Google Scholar
    • Export Citation
  • 5

    Mascarello M, Lanzafame M, Lattuada E, et al: Progressive multifocal leukoencephalopathy in an HIV patient receiving successful long-term HAART. J Neurovirol 17: 196, 2011.

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    • Search Google Scholar
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Bilateral Ankle Clonus as Initial Manifestation of Progressive Multifocal Leukoencephalopathy

A Case Report

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  • 1 Department of Podiatric Surgery, Scripps Mercy Hospital, San Diego, CA. Dr. Cozzetto is now with the Department of Podiatric Surgery, Mercy Medical Group/Dignity Health Foundation, Sacramento, CA.
  • | 2 Department of Infectious Disease, Scripps Mercy Hospital, San Diego, CA.
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We report on a rare case of foot and ankle clonus as the initial presentation of progressive multifocal leukoencephalopathy in a young patient with no known history of HIV or AIDS and no significant past medical or social history. The patient came to the emergency department with a chief complaint of muscle spasms in his lower extremities and unsteadiness in gait. The patient was diagnosed as having bilateral ankle clonus. Work-up revealed an absolute lymphocyte CD4+ count of 18, an HIV viral load of 1,690,000, and a positive John Cunningham virus polymerase chain reaction in the cerebral spinal fluid, indicating that the patient had progressive multifocal leukoencephalopathy and AIDS. The diagnosis of progressive multifocal leukoencephalopathy should be in the foot and ankle surgeon's differential diagnosis when a patient presents with neurological symptoms in the lower extremities.

Corresponding author: Dana Cozzetto, DPM, Mercy Medical Group/Dignity Health Foundation, 6555 Coyle Ave, Carmichael, CA 95608. (E-mail: dana_cozzetto@yahoo.com)