People living with HIV presenting with hemiparesis: what are the possible causes?

Authors

  • Yovita Gotama Department of Internal Medicine, Wangaya Regional General Hospital, Denpasar, Bali, Indonesia
  • Ketut Suryana Department of Internal Medicine, Wangaya Regional General Hospital, Denpasar, Bali, Indonesia

DOI:

https://doi.org/10.18203/2349-3933.ijam20242317

Keywords:

Hemiparesis, HIV, PLWH, Stroke, TE

Abstract

People living with HIV (PLWH) are commonly associated with opportunistic infections, particularly with low CD4 count, less than 200 cells/μL. Neurological manifestation can be occurred 70% in PLWH and the most symptoms is hemiparesis, seizure, headache, behavioural changes, decrease of consciousness, and cognitive impairment but depends on the localization of the brain lesions. We present a case of 53-year-old man with initial presentation of right hemiparesis and was on highly active antiretroviral therapy (HAART). With laboratory and CT-scan result, the patient diagnosed with stroke ischemic and occurred at the same time with toxoplasma encephalitis (TE) as an opportunistic infection. In PLWH, many possible causes involve central nervous system-caused hemiparesis. The initial differential diagnosis should be considered to prevent delayed treatment and potential of severe complications.

References

Paruk HF, Bhigjee AI. Review of the neurological aspects of HIV infection. J Neurol Sci. 2021;425(8):117453.

Amod F, Holla VV, Ojha R, Pandey S, Yadav R, Pal PK. A review of movement disorders in persons living with HIV. Park Relat Disord. 2023;114(5):105774.

Gp K, Sagar H, Bv R. Study of central nervous system manifestation in HIV / AIDS patient. 2019;1(2):41-4.

Manwani B, Stretz C, Sansing LH. Stroke as the initial manifestation of the human immunodeficiency virus. Stroke. 2016;47(4):e60-2.

Graham AK, Fong C, Naqvi A, Lu JQ. Toxoplasmosis of the central nervous system: Manifestations vary with immune responses. J Neurol Sci. 2021;420(10):117223.

Emuze BO, Jain MS, Luvsannyam E, Bhaya P, Vaquero C. Central Nervous System Toxoplasmosis and Cytomegalovirus Colitis in an Asymptomatic HIV Positive Patient Case Presentation. Cureus. 2021;13(9):8-11.

Hosoda T, Mikita K, Ito M, Nagasaki H, Sakamoto M. Cerebral toxoplasmosis with multiple hemorrhage lesions in an HIV infected patient: A case report and literature review. Parasitol Int. 2021;81(11):102280.

Roslan SR, Abdul Hadi A. Seizure as Initial Presentation of HIV: A Case Report of Cerebral Toxoplasmosis. Malaysian J Med Res. 2022;06(02):01-5.

Baeza N, Cohendoz S, Valentini RN, Stryjewski ME, Carena AA. Spinal Cord Involvement and Brain Hemorrhage as an Atypical Presentation of Toxoplasmosis in a Patient with HIV. SN Compr Clin Med. 2021;3(8):1796-800.

Weidauer S, Wagner M, Enkirch SJ, Hattingen E. CNS Infections in Immunoincompetent Patients: Neuroradiological and Clinical Features. Clin Neuroradiol. 2020;30(1):9-25.

Septa D, Imran Y, Pragono RY. Diagnosis and Treatment of Tuberculous Meningoencephalitis and Toxoplasma Encephalitis in Positive HIV Patient: Case Report. J Biomedika dan Kesehat. 2022;5(3):221-7.

Layton J, Theiopoulou DC, Rutenberg D, Elshereye A, Zhang Y, Sinnott J, et al. Clinical Spectrum, Radiological Findings, and Outcomes of Severe Toxoplasmosis in Immunocompetent Hosts: A Systematic Review. Pathogens. 2023;12(4):1-58.

Feitoza L de M, Stucchi RSB, Reis F. Neurosyphilis vasculitis manifesting as ischemic stroke. Rev Soc Bras Med Trop. 2020;53(1):1-2.

Martínez-Ayala P, Quiñonez-Flores A, González-Hernández LA, Ruíz-Herrera VV, Zúñiga-Quiñones S, Alanis-Sánchez GA, et al. Clinical features associated with neurosyphilis in people living with HIV and late latent syphilis. Int J STD AIDS. 2022;33(4):330-6.

Lei T, Deng A, Li L, Wang M, Wu D, Zhou T. Progressive multifocal leukoencephalopathy in an HIV patient: A case report and literature review . Clin Case Rep. 2023;11(8):1-5.

Gandh A. Progressive multifocal leukoencephalopathy in an immunocompetent patient. Neurologia. 2020;35(1):58.

Jabbari E, Ruiz F, Lee SFK, Jabeen F, Brandner S, Kidd DP, et al. Clinical Reasoning: Progressive Hemiparesis and White Matter Abnormalities in an HIV-Negative Patient. Neurology. 2023;100(24):1156-63.

Sharma K, Riunga F, Sokhi DS. Neurological manifestations of cytomegalovirus infection with immune reconstitution syndrome in patients with poorly-controlled HIV. PAMJ Clin Med. 2020;4:124.

Tang Y, Sun J, He T, Shen Y, Liu L, Steinhart CR, et al. Clinical Features of Cytomegalovirus Retinitis in HIV Infected Patients. Front Cell Infect Microbiol. 2020;10(4):1-6.

Zhao M, Zhuo C, Li Q, Liu L. Cytomegalovirus (CMV) infection in HIV/AIDS patients and diagnostic values of CMV-DNA detection across different sample types. Ann Cardiothorac Surg. 2020;9(5):2710-5.

Nguyen AM, Decker JA, Dupuis JE, Little AA, Ottenhoff LD, Rajajee V, et al. A 57 Year-Old Man With HIV Presenting With Severe Headache and Progressive Weakness. Neurohospitalist. 2022;12(1):171-6.

Downloads

Published

2024-08-27