Atypical HIV-vacuolar myelopathy: a case report

Abstract

Background Here, we report an atypical HIV-vacuolar myelopathy and search the available medical literature about atypical presentations of human immunodeficiency virus associate vacuolar myelopathy (HIV-VM) and immunoglobulin therapy response. Case A 26-year-old lady who was 4 weeks postpartum presented to us with acute flaccid quadriparesis, with no sensory level. Extensive workup ruled out other causes of myelopathy. She developed a stage 3 acute kidney injury, and MRI showed diffuse cord atrophy involving the lower cervical and thoracic cord. The patient received IV-immunoglobulin, ARVs, and supportive therapy with inadequate response. Unfortunately, she developed nosocomial pneumonia and died. Discussion In HIV-VM, there is spinal cord atrophy, which mainly involves the thoracic cord. In our case, this pathological process also affected the spinal cord's cervical region, leading to flaccid tetraplegia, with high CD4 level, without response to the treatment, including intravenous immunoglobulin. Keynotes Vacuolar myelopathy, HIV, Immunoglobulin therapy, flaccid tetraplegia, hypokalaemia. Renal failure.

The utility of diffusion-weighted imaging in patients with spinal cord infarction: difference from the findings of neuromyelitis optica spectrum disorder

“…Posterior linear hyperintensity was often observed in patients with PSA ischemia, whereas it was not found in the NMOSD group. Although similar linear lesions on T2 may be observed in acquired immunodeficiency syndrome-related vacuolar myelopathy [ 37 ], copper deficiency [ 38 ], neurosyphilis [ 39 ], nitrous oxide intoxication [ 40 ], Sjögren syndrome [ 41 ], subacute combined degeneration of the spinal cord [ 42 ], and subacute myelo-optico-neuropathy (i.e., side effects of clioquinol) [ 43 ], posterior linear DWI hyperintensity that has low-ADC values is possibly more specific for SCI due to the same aforementioned reasons. Owl’s eyes sign, pencil-like hyperintensity, and posterior linear hyperintensity can be observed on DWI with the corresponding low-ADC region and may contribute to the diagnosis of SCI.…”

Blood‐borne viruses and neurological manifestations: An overview

“…HIV‐associated vacuolar myelopathy (HIV‐VM) is the main cause of myelopathy in patients with HIV/AIDS, ranging from 22% to 55% of the cases, worldwide. HIV‐VM is the most frequent form of spinal cord disorder in individuals with HIV, which causes damage to the myelin sheath protecting nerve cells, leading to the formation of tiny vacuoles in the nerve fibres 23,24 . This condition is progressive with spastic paraparesis, sensory ataxia, and autonomic dysfunction that resembles subacute combined degeneration observed in vitamin B12 deficiency and other neurological disorders 25 .…”

“…HIV-VM is the most frequent form of spinal cord disorder in individuals with HIV, which causes damage to the myelin sheath protecting nerve cells, leading to the formation of tiny vacuoles in the nerve fibres. 23,24 This condition is progressive with spastic paraparesis, sensory ataxia, and autonomic dysfunction that resembles subacute combined degeneration observed in vitamin B12 deficiency and other neurological disorders. 25 Initially, before the introduction of antiretroviral treatment in individuals with AIDS, HIV-VM was reported as a progressive condition leading to death within months of diagnosis, often accompanied by HAD.…”

“…Possible causes that need to be ruled out include HIV-associated transverse myelitis, viral infections (e.g., CMV, Varicella-Zoster, herpes simplex, HTLV-1/2), bacterial infections (e.g., tuberculosis, neurosyphilis), multiple sclerosis, and compressive myelopathy. 23 The most common symptoms of HIV-VM are progressive weakness in the lower extremities, gait disorder, increased frequency and urgency of urination, and erectile dysfunction in men. 24 Although supportive treatment is the primary mode of care, highly active antiretroviral therapy (HAART) or intravenous immunoglobulin (IVIG) can also improve HIV-VM.…”

HIV-Associated Vacuolar Myelopathy and HIV-Associated Neurocognitive Disorder as an Initial Presentation in HIV Infection

“…In a trial to assess the effectiveness of IVIg in patients with VM, Cirkurel et al found lessened lower limb palsy, which may be related to IVIg's anti-inflammatory properties [ 10 ]. Based on this evidence, IVIG has been attempted in several other studies, where it is found to be effective in HAART-resistant VM cases [ 8 ], but in other studies, it is found to be ineffective [ 11 ].…”