A Rare Case of HIV-Induced Inflammatory Demyelinating Polyneuropathy

Abin Sajan BS¹, Soombal Zahid DO², Jordan Stumph MD², Daniel Griepp BE¹, Sami Saba MD², Nazish Ilyas MD² and Isabel M. Mc Farlane MD^1,

¹Department of Medicine, SUNY Downstate Medical Center, 450 Clarkson Avenue Brooklyn, NY 11203 (718) 270-2030

²Department of Medicine, Lenox Hill Hospital, Department of Medicine, 100 E 77th Street New York, NY 10075 (212) 434-2000

Cite this paper

Abin Sajan BS, Soombal Zahid DO, Jordan Stumph MD, Daniel Griepp BE, Sami Saba MD, Nazish Ilyas MD and Isabel M. Mc Farlane MD. A Rare Case of HIV-Induced Inflammatory Demyelinating Polyneuropathy. American Journal of Medical Case Reports. 2019; 7(1):5-8. doi: 10.12691/AJMCR-7-1-2

Abstract

Background: Acute inflammatory demyelinating polyneuropathy (AIDP) is an uncommon form of neuropathy in HIV-infected patients that can cause pain, sensory disturbance, and motor weakness. Case presentation: A 23-year-old African American male with past medical history of Guillain-Barre Syndrome (GBS), Lyme disease, and sexually transmitted infections including syphilis and chlamydia presented with acute back pain radiating to bilateral lower extremities with worsening right foot weakness for four days. Cerebrospinal fluid (CSF) studies including meningoencephalitis panel were negative as well as blood tests for Lyme disease and HIV antibody testing. Patient was initially treated with penicillin for positive treponemal serology but without improvement in lower extremity weakness. Electromyogram showed evidence of early demyelinating motor polyneuropathy. Four days after presentation, repeat HIV antibody testing returned positive. Recurrent AIDP in this case was suspected to be secondary to acute HIV infection, and highly active antiretroviral therapy (HAART) was administered along with intravenous immunoglobulin (IVIG). Muscle strength improved with therapy and patient was expected to have continued improvement with intensive rehabilitation after discharge. Conclusion: Acute inflammatory demyelinating polyneuropathy (AIDP) tends to present early in course of HIV infection. Therefore, HIV testing should be obtained in individuals presenting with new neurological deficits. Our patient received HAART therapy, in addition to the traditional modalities to manage AIDP, which led to a substantial recovery of his sensorimotor function.

Keywords

human immunodeficiency virus, acute inflammatory demyelinating polyneuropathy, Guillain-Barre syndrome, intravenous immunoglobulin, peripheral neuropathy, chronic inflammatory demyelinating polyneuropathy, highly active antiretroviral therapy

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

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