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Published on: September 19, 2010
Acute transient inflammatory leukoencephalopathy in HIV
E Tavazzi1, L Magrassi, A Maccabruni
1Department of General Neurology, IRCCS National Neurological Institute C Mondino IRCCS, via Mondino 2, 27100 Pavia, Italy. eleonora.tavazzi@mondino.it
Summary
A rare case of acute inflammatory leukoencephalopathy in an HIV+ woman, resembling ADEM, fully recovered with steroids, IVIG, and HAART. This highlights considering ADEM in HIV-related leukoencephalopathy diagnoses.
Area of Science:
- Neurology
- Infectious Diseases
- Neuroimmunology
Background:
- HIV-related acute inflammatory leukoencephalopathy (AIL) presents with sudden neurological symptoms and brain lesions.
- Diagnosis can be challenging due to varied presentations in immunocompromised individuals.
Observation:
- A 31-year-old HIV+ woman developed acute cognitive decline, hemiparesis, and dysphasia.
- Brain MRI revealed a large contrast-enhancing lesion; biopsy confirmed inflammation without an identified pathogen.
Findings:
- The patient received steroids, gammaglobulins, and highly active antiretroviral therapy (HAART).
- Complete clinical recovery and lesion resolution on follow-up MRI were observed.
- The presentation mimicked acute disseminated encephalomyelitis (ADEM).
Implications:
- This case suggests ADEM should be considered in the differential diagnosis of HIV-related leukoencephalopathy, even with atypical features.
- HIV-related immunodeficiency may alter the typical presentation and course of neurological conditions like ADEM.
- Prompt treatment with immunomodulatory therapy and HAART can lead to favorable outcomes in such cases.
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