A great simulator in clinical practice: mononeuritis multiplex in HIV infection

Area of Science:

• Immunology
• Neurology
• Infectious Diseases

Background:

• Human Immunodeficiency Virus (HIV) infection can present with diverse clinical manifestations, often mimicking other conditions.
• Autoimmune phenomena are increasingly recognized as significant contributors to HIV-related morbidity.
• Vasculitis, particularly polyarteritis nodosa-like presentations, is an uncommon but serious complication of HIV.

Observation:

• A previously healthy 39-year-old woman presented with a 2-month history of arthritis, weight loss, and confluent multiple mononeuropathy.
• Extensive investigations revealed HIV serology positivity with a CD4 count of 100 cells/mm³.
• Nerve biopsy demonstrated necrotizing vasculitis, confirmed not to be associated with Cytomegalovirus (CMV) co-infection.

Findings:

• The patient was diagnosed with polyarteritis nodosa-like vasculitis in the context of HIV infection.
• The clinical presentation underscores HIV's ability to mimic various systemic diseases.
• Necrotizing vasculitis in this case was attributed to HIV-related autoimmunity rather than opportunistic infection.

Implications:

• This case emphasizes the importance of considering HIV infection in the differential diagnosis of vasculitis syndromes.
• Recognizing HIV-associated autoimmunity is critical for accurate diagnosis and appropriate management of complex presentations.
• Understanding the multifaceted nature of HIV infection is essential for improving patient outcomes and diagnostic strategies.