HIV infection as atypical cause of demyelination (PP-09)

Background and aims: Demyelinating lesions secondary to primary HIV infection are highly infrequent, with only a few case reports published in the literature. In this context, we should rule out other diagnoses, such as progressive multifocal leukoencephalopathy, primary CNS lymphoma, acute disseminated encephalomyelitis, toxoplasmosis, cytomegalovirus, cryptococcosis, and multiple sclerosis. We present a case about this rare entity.
Methods: A 38-year-old male, current smoker and diagnosed with hypertension under no treatment, presented blurry vision and a hypertensive crisis. One month ago, he had experimented similar symptomatology, with completely spontaneous recovery. On physical examination he showed a right temporal hemianopsia, without delirium or another focal neurologic deficit.
Results: Brain MRI showed a lesion in the corpus callosum and left frontal lobe, hypointense on T1 and hyperintense on T2 and FLAIR, with little restriction (predominantly peripheral) in diffusion and no enhancement after gadolinium administration; stable in successive imaging tests. The results of the blood analysis were: HIV positive; serology tests for HCV, syphilis, toxoplasma and cryptococcal negative; CMV IgM negative, CMV IgG positive; CD4 428. The CSF showed a hyperproteinorraquia, IgG OCBs with a mirror pattern and negative cytology. Clinical stability had been achieved after starting antiretroviral therapy, with no new lesions.
Conclusion: An exhaustive approach in HIV patients who shows demyelinating lesions is essential for making a right diagnosis because the primary infection can be the cause.