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Abstract Details

Acute Hemorrhagic Leukoencephalitis as a Primary Presentation in an Immunocompromised Patient With Cerebral Toxoplasmosis
Autoimmune Neurology
P12 - Poster Session 12 (5:30 PM-6:30 PM)

AHLE is a rare, hyper-acute variant of Acute Disseminated Encephalomyelitis (ADEM). It is often preceded by an upper respiratory infection, and associated pathogens include influenza, Epstein Barr Virus (EBV), mycoplasma pneumonia, and SARS-CoV-2. 

To draw attention towards a devastating presentation of Acute Hemorrhagic Leukoencephalitis (AHLE) in an immunocompromised patient with cerebral toxoplasmosis.


A 27-year-old man presented to our hospital with a three day history of headaches and altered mental status. He was having seizures on arrival. He had a Glasgow Coma Scale (GCS) of 4 upon arrival. His pupils were anisocoric and sluggish to light. His brainstem reflexes were intact. Motor exam revealed extensor posturing in bilateral upper extremities and triple flexion in bilateral lower extremities in response to noxious stimuli. He received lorazepam in the emergency room with minimal improvement and was ultimately intubated for airway protection. Computed tomography (CT) head showed regions of hypoattenuation involving bilateral basal ganglia and thalami with superimposed acute hemorrhage, significant mass effect, and patchy regions of acute hemorrhage in the cerebellum. Magnetic resonance imaging (MRI) brain revealed areas of confluent FLAIR signal abnormality in the deep white matter, bilateral basal ganglia and thalami, brainstem, and throughout the cerebellum. He had a hypercellular cerebral spinal fluid (CSF) analysis that showed white blood cell count of 218 with lymphocytic predominance. Protein was elevated to 412 mg/dl and glucose was 17 mg/dl. He was found to be HIV-1 positive with a CD4 count of 6 cells per cubic centimeter. CSF specific toxoplasmosis PCR showed 730,000 copies/milliliter. He was treated with solumedrol and broad-spectrum antimicrobials with minimal improvement in his clinical picture and ultimately succumbed to his disease.

This report highlights AHLE as a rapidly progressive hemorrhagic demyelination of white matter. It is imperative to recognize it to implement life saving therapies earlier in the course.

Sukriye Damla Kara, MD (University of Mississippi Medical Center)
Dr. Kara has nothing to disclose.
Lindsey M. Ladd, DO (University Of Mississippi Medical Center) Dr. Ladd has nothing to disclose.
No disclosure on file
Maryam Zulfiqar, MD (Medical University of South Carolina) Dr. Zulfiqar has nothing to disclose.
No disclosure on file