[The 518th case: multiple intracranial lesions, fever, rash]

This article reports the case of a 58-year-old male patient who presented with a generalized rash, intermittent fever, and a concomitant perianal abscess, as well as mycoplasma pneumoniae psittacosis. The initial symptom was episodic slurred speech, which progressively developed into symptoms such as delayed responses and left-sided limb weakness. Cranial magnetic resonance imaging revealed gradually progressive intracranial lesions characterized primarily by asymmetric white matter damage, with no enhancement upon contrast administration. Serum HIV antibody testing was positive. Next-generation sequencing of pathogens in the cerebrospinal fluid detected DNA from hepatitis B virus, John Cunningham (JC) virus, and Epstein-Barr virus. The patient was ultimately diagnosed with AIDS combined with progressive multifocal leukoencephalopathy. This case highlights that for lesions predominantly involving the white matter with an asymmetric bilateral distribution, the possibility of progressive leukoencephalopathy should be considered, and HIV antibody screening is warranted.