Diagnostic, and therapeutic challenges In HIV+ patient, presented with left-sided Haemiparesis and MRI changes

Abstract

Neurological features occur during the later stages of HIV infection. The most common manifestations are opportunistic infections like cerebral toxoplasmosis and progressive multifocal leukoencephalopathy, as well as malignant lymphomas like primary EBV associated CNS lymphoma. We present a case of a 21-yearold man, diagnosed as HIV+ in 2010. The patient receives HAART (kivexa/kaletra) from 13.08.2013 to date with poor adherence. The current complaints began two weeks ago with weakness in the lower extremities, gait disturbances and headache. The neurological examination at the admission time showed no meningeal signs, weakened tendon reflexes in left limbs, absent abdominal reflexes, central facial palsy on the left, positive Babinski sign. Upon admission to the hospital the patient presented with CD 4-34c/mm³, VL- 2180 c/ml. Cerebral spinal fluid viral load was <20 c/ml. The results of the serological and virological tests from cerebral spinal fluid were: PCR EBV (-); PCR CMV (-); IgM EBV (-); IgG CMV (-); T.gondii IgM (-); IgG(-); PCR for pathogenic free-living amoeba (-). MRI: space occupying lesion, interpreted as a lymphoma, MRI after 6 months: progression of the lesion. A biopsy of peripheral lymph node showed nonspecific finding. The patient was put on patogenetic treatment against cerebral edema, treatment against T. gondii infection (clindamycin, co-trimoxazole), and gancyclovir, meronem, fungolon, ART as well. The patient was without precise, laboratory confirmed diagnosis, but the general condition is better.