Unveiling epilepsia partialis continua as an early indicator of HIV encephalitis

A young male with no known addictions and comorbidities presenting with recurrent clonic-myoclonic movements, initially localized to the left corner of the mouth and left upper limb, evolving into epilepsia partialis continua, despite appropriate sequential antiepileptic medications, subsequently progressed to refractory status epilepticus. He was tested positive for HIV infection and his neuroimaging revealed nonenhancing lesions, a novel finding in HIV-related encephalitis. We managed him with intravenous immunoglobulin along with multiple antiepileptic medications and highly active antiretroviral therapy (ART), and he exhibited a rapid clinical recovery over 3 weeks. This case highlights the importance of initiating immunomodulatory therapy promptly at presentation and underscores the challenges of managing drug interactions between antiepileptic drugs and antiretroviral therapy (ART), emphasizing the need for careful selection of medications in HIV-infected individuals.