Human Immunodeficiency Virus Seroconversion Syndrome Presenting as Facial Diplegia and Aseptic Meningitis: A Case Report (P1.327)

We describe an HIV seroconversion syndrome presenting with facial diplegia and aseptic meningitis. DESCRIPTION: Patient is a 44 year old male with known uncontrolled hypertension. Three weeks prior to presentation he suffered a transient febrile illness while vacationing and was treated presumptively for malaria in Côte d’Ivoire. One week later, he experienced a migrainous headache with pronounced bucco-labial dysarthria, meningismus and dysguesia. Examination revealed hypertensive urgency, bilateral lower motor neuron (LMN) facial paralysis, and mild meningeal irritation. Initial investigations revealed renal impairment (acute on chronic) and left ventricular hypertrophy, both ascribed to presumed chronic hypertension. Gradient echo sequence of brain MRI revealed microhemorrhages with dystrophic calcifications, along with microangiopathic changes. CSF revealed WBC of 55 (lymphocytic), normal glucose, and a total protein of 0.67g/L. Blood, CSF, and urine samples were negative for all common infectious pathogens (including malaria), except HIV (confirmed by Western Blot) and Lyme antibodies. Initial CD4 count was 176 cells/μL, increasing to 230 within a week, with a viral load of 419,289 copies/ml. Patient received HAART and ceftriaxone for possible concomitant Lyme infection. Headache greatly improved, but facial weakness persisted three weeks after presentation. Upon further questioning, patient admitted to an unprotected sexual encounter. COMMENTS: LMN fa...
Source: Neurology - Category: Neurology Authors: Tags: HIV/AIDS Source Type: research