Acute paraparesis in HIV-infected patient after initiation of highly active antiretroviral therapy.

Journal of Neurovirology
Preeti DalalSanjay D'Cruz

Abstract

Neurological syndromes occur in around 40-70% of HIV-infected people. Direct central nervous system involvement by the virus usually manifests as HIV encephalitis, HIV leucoencephalopathy, vacuolar leucoencephalopathy or vacuolar myelopathy. Indirect involvement is usually associated with neurotropic opportunistic infections which include tuberculosis, toxoplasmosis, cryptococcosis and viral encephalitis such as herpes simplex, varicella-zoster, cytomegalovirus and Human polyomavirus 2. We report a case of transverse myelitis in a recently diagnosed HIV patient who was otherwise asymptomatic initially and developed paraparesis after 1 month of initiation of antiretroviral therapy. After ruling out opportunistic infections and other causes of compressive and non-compressive myelopathy, development of transverse myelitis was attributed to immune reconstitution inflammatory syndrome in view of baseline low CD4 count and their improvement after HAART initiation. Prompt treatment with corticosteroids successfully reversed the symptoms.

References

Dec 14, 2007·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Yukari C ManabeRichard D Moore
Aug 11, 2010·Current Neurology and Neuroscience Reports·Micheline McCarthy, Avindra Nath
Nov 1, 2013·Current Infectious Disease Reports·Nathan BahrGraeme Meintjes
Mar 22, 2014·BMC Infectious Diseases·Paulo AndradeAntónio Sarmento
Apr 2, 2018·Handbook of Clinical Neurology·Lauren BowenBryan Smith

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