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PARAPARESIS IN A PATIENT WITH ADVANCED HIV DISEASE WITHOUT MANIFESTATIONS OF OPPORTUNISTIC INFECTION
A A Onifade1, T A Ajadi2, I O Jimoh3
1Department of Chemical Pathology, College of Medicine, University of Ibadan, Oyo State.
Annals of Ibadan Postgraduate Medicine
|July 17, 2020
Summary
This case highlights an unusual HIV presentation where paraparesis, or leg weakness, occurred without typical symptoms. Early antiretroviral therapy led to symptom resolution, emphasizing prompt diagnosis.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- Human Immunodeficiency Virus (HIV) infection typically presents with constitutional symptoms.
- Neurological manifestations of HIV are diverse, but paraparesis without constitutional signs is uncommon.
Purpose of the Study:
- To report an unusual case of paraparesis as the primary manifestation of HIV infection.
- To emphasize the importance of considering HIV in patients with unexplained neurological deficits.
Main Methods:
- Case report of a 43-year-old male presenting with progressive lower limb weakness and urinary difficulties.
- Diagnostic workup included urethroscopy, prostate biopsy, cranial CT, and lumbo-sacral MRI.
- HIV screening and confirmatory tests were performed, along with CD4 count and plasma viral load determination.
Main Results:
- The patient exhibited paraparesis without constitutional symptoms of advanced HIV.
- Imaging revealed degenerative changes suggestive of immunosuppression.
- HIV-1 antibody reactivity was confirmed, with a CD4 count of 226 cells/mm³ and viral load of 126,000 copies/ml.
Conclusions:
- Paraparesis can be an atypical presenting symptom of HIV infection.
- Prompt initiation of antiretroviral therapy resulted in the resolution of neurological symptoms.
- This case underscores the need for comprehensive diagnostic evaluation in atypical presentations.
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