Polyneuropathy associated with the diffuse infiltrative lymphocytosis syndrome

Area of Science:

• Immunology
• Neurology
• Infectious Diseases

Background:

• Diffuse infiltrative lymphocytosis syndrome (DILS) is an HIV-associated condition characterized by lymphocyte infiltration of tissues, typically causing parotid enlargement and sicca syndrome.
• Extraglandular manifestations, such as interstitial pneumonitis, are common initial presentations of DILS.
• Diagnosis often relies on characteristic symptoms, potentially delaying recognition of atypical presentations.

Observation:

• A case report details an HIV-positive patient presenting with polyradiculoneuropathy as the primary symptom of DILS.
• The patient exhibited no parotid gland enlargement or interstitial pneumonitis, classic signs of DILS.
• Minor salivary gland biopsy confirmed chronic inflammation and lymphoid aggregates, supporting the DILS diagnosis.

Findings:

• The atypical DILS presentation involved polyradiculoneuropathy without the typical parotid or pulmonary involvement.
• Minor salivary gland biopsy proved crucial in diagnosing DILS in this unusual case.
• Treatment with prednisone resulted in rapid symptom improvement.

Implications:

• Clinicians should consider DILS in the differential diagnosis of HIV-positive individuals with peripheral neuropathy, even without classic DILS symptoms.
• Recognizing diverse extraglandular manifestations of DILS is vital for timely diagnosis and management in HIV patients.
• This case broadens the understanding of DILS's clinical spectrum, particularly in patients with preserved CD4 counts.