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Encephalopathy and cytomegalovirus colitis in an AIDS child
1Department of Pediatrics, Osaka City General Hospital, Japan. togawa@ocgh.hospital.city.osaka.jp
Insights
This case study details a child with vertically transmitted HIV presenting with neurological issues and chronic diarrhea. Treatment responses varied, highlighting challenges in managing pediatric AIDS and associated opportunistic infections.
Area of Science:
- Pediatric infectious diseases
- Neurovirology
- Immunology
Background:
- Vertical transmission of Human Immunodeficiency Virus type-1 (HIV) in a 2-year-old girl.
- Co-occurrence of prolonged thrush and spastic diplegia.
Observation:
- Brain CT revealed symmetrical calcification in basal ganglia and periventricular white matter.
- Diagnosis of Acquired Immune Deficiency Syndrome (AIDS) encephalopathy with pyramidal tract disorder, but no intellectual deficit.
- Initial increase in CD4 count with zidovudine (ZDV) monotherapy, followed by a decrease.
Findings:
- Combination therapy with ZDV and didanosine, later switched to ZDV and lamivudine due to intolerance.
- Development of chronic diarrhea leading to wasting syndrome, with cytomegalovirus (CMV) confirmed in colon biopsy.
- Ganciclovir treatment temporarily resolved diarrhea and improved weight, but symptoms recurred with progressive emaciation.
Implications:
- Case provides insights into managing neurological complications and opportunistic infections in pediatric HIV/AIDS.
- Highlights the complex interplay between viral load, treatment regimens, and clinical outcomes in children.
- Suggests potential therapeutic strategies for cytomegalovirus-induced enteritis in pediatric AIDS patients.
Abstract:
A 2-year-old girl, who had prolonged thrush and spastic diplegia, was found to have a mother-to-child vertical transmission of human immunodeficiency virus type-1 (HIV). A brain computed tomography scan revealed a symmetrical calcification on the bilateral basal ganglia and periventricular white matter. She had an acquired immune deficiency syndrome (AIDS) encephalopathy of pure dominant pyramidal tract disorder without an intellectual deficit. Helper cell lymphocyte count (CD4) increased with the beginning of zidovudine (ZDV, also known as AZT) monotherapy but began to decrease after the 4th week to reach the baseline at 20th week. Zidovudine plus didanosine combination therapy was started at the 68th week, but because of intolerance, the combination was changed to ZDV plus lamivudine at the 98th week. By the 80th week, neither severe opportunistic infection nor deterioration of the neurological status was recognized, but chronic diarrhea appeared. The diarrhea advanced to the wasting syndrome at the age of 4 years and cytomegalovirus genome was confirmed in a biopsied specimen of the colon. Ganciclovir treatment was effective in stopping the diarrhea and increasing her bodyweight, but after the age of 5, resumption of diarrhea was followed by progressive emaciation and weakness. This work may provide some clues in treating children's AIDS.