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HIV-Associated Vacuolar Myelopathy and HIV-Associated Dementia as the Initial Manifestation of HIV/AIDS.
Case Rep Infect Dis 2019; 2019:3842425CR

Abstract

HIV-associated vacuolar myelopathy (HIV-VM) is the most common cause of spinal disease in HIV/AIDS. HIV-VM causes progressive spastic paraparesis, sensory ataxia, and autonomic dysfunction. It is a progressive myelopathy that shares features with subacute combined degeneration seen in vitamin B12 deficiency as well as other neurological diseases and can occur synchronously with HIV-associated dementia (HAD). Here, we describe a rare case in which a patient's initial presentation of HIV/AIDS was both HIV-VM and HAD. A fifty-three-year-old man presented with a six-month history of numerous falls due to progressive gait instability with associated memory loss, tremor, urinary retention, and impotence. His exam was significant for hyperreflexia and weakness in bilateral lower extremities, upgoing plantar reflex, dysmetria, and ataxic gait. MRI-brain was notable for nonspecific volume loss and diffusely increased T2 signal throughout the supratentorial white matter. Lumbar puncture showed isolated lymphocytic pleocytosis with all other CSF testing unremarkable. He ultimately tested positive for HIV-1, with a CD4 count of 157 cells/mm3 and a viral load of 874,000 copies/mL. He was diagnosed with HIV-VM and HAD which improved after several months of antiretroviral therapy. This case highlights the importance of considering HIV testing in a patient with a sensory neuropathy and/or progressive cognitive impairment.

Authors+Show Affiliations

Internal Medicine Residency Training Program, Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, MO, USA.Internal Medicine Residency Program at University of Illinois at Chicago/Advocate Christ Medical Center, Oak Lawn, IL, USA.Internal Medicine Residency Training Program, Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, MO, USA.Internal Medicine Residency Training Program, Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, MO, USA.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

31637067

Citation

Wuliji, Natalia, et al. "HIV-Associated Vacuolar Myelopathy and HIV-Associated Dementia as the Initial Manifestation of HIV/AIDS." Case Reports in Infectious Diseases, vol. 2019, 2019, p. 3842425.
Wuliji N, Mandell MJ, Lunt JM, et al. HIV-Associated Vacuolar Myelopathy and HIV-Associated Dementia as the Initial Manifestation of HIV/AIDS. Case Rep Infect Dis. 2019;2019:3842425.
Wuliji, N., Mandell, M. J., Lunt, J. M., & Merando, A. (2019). HIV-Associated Vacuolar Myelopathy and HIV-Associated Dementia as the Initial Manifestation of HIV/AIDS. Case Reports in Infectious Diseases, 2019, p. 3842425. doi:10.1155/2019/3842425.
Wuliji N, et al. HIV-Associated Vacuolar Myelopathy and HIV-Associated Dementia as the Initial Manifestation of HIV/AIDS. Case Rep Infect Dis. 2019;2019:3842425. PubMed PMID: 31637067.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - HIV-Associated Vacuolar Myelopathy and HIV-Associated Dementia as the Initial Manifestation of HIV/AIDS. AU - Wuliji,Natalia, AU - Mandell,Matthew J, AU - Lunt,Jason M, AU - Merando,Adam, Y1 - 2019/09/15/ PY - 2019/02/24/received PY - 2019/06/12/accepted PY - 2019/10/23/entrez PY - 2019/10/23/pubmed PY - 2019/10/23/medline SP - 3842425 EP - 3842425 JF - Case reports in infectious diseases JO - Case Rep Infect Dis VL - 2019 N2 - HIV-associated vacuolar myelopathy (HIV-VM) is the most common cause of spinal disease in HIV/AIDS. HIV-VM causes progressive spastic paraparesis, sensory ataxia, and autonomic dysfunction. It is a progressive myelopathy that shares features with subacute combined degeneration seen in vitamin B12 deficiency as well as other neurological diseases and can occur synchronously with HIV-associated dementia (HAD). Here, we describe a rare case in which a patient's initial presentation of HIV/AIDS was both HIV-VM and HAD. A fifty-three-year-old man presented with a six-month history of numerous falls due to progressive gait instability with associated memory loss, tremor, urinary retention, and impotence. His exam was significant for hyperreflexia and weakness in bilateral lower extremities, upgoing plantar reflex, dysmetria, and ataxic gait. MRI-brain was notable for nonspecific volume loss and diffusely increased T2 signal throughout the supratentorial white matter. Lumbar puncture showed isolated lymphocytic pleocytosis with all other CSF testing unremarkable. He ultimately tested positive for HIV-1, with a CD4 count of 157 cells/mm3 and a viral load of 874,000 copies/mL. He was diagnosed with HIV-VM and HAD which improved after several months of antiretroviral therapy. This case highlights the importance of considering HIV testing in a patient with a sensory neuropathy and/or progressive cognitive impairment. SN - 2090-6625 UR - https://www.unboundmedicine.com/medline/citation/31637067/HIV-Associated_Vacuolar_Myelopathy_and_HIV-Associated_Dementia_as_the_Initial_Manifestation_of_HIV/AIDS L2 - https://dx.doi.org/10.1155/2019/3842425 DB - PRIME DP - Unbound Medicine ER -