Acute Disseminated Encephalomyelitis: An Unusual Presentation of Human Immunodeficiency Virus Infection

Abstract

Background. Acute disseminated encephalomyelitis (ADEM) is a rare inflammatory and demyelinating disorder of the central nervous system, with a distinct tendency to a perivenous localization of pathological changes. Children are the most affected population and frequently presented after exanthematous viral infections or vaccination. Due to the rarity of this disease, the annual incidence rate in the population is not precisely known. Case Presentation. Here, we present a 28-year-old male HIV-1 positive patient with an acute confusional state, a diminished alert status characterized by somnolence, hypoprosexia, and complex visual hallucinations. Neuroimages reported white matter demyelinating lesions, mainly affecting the semioval centers, the frontal lobe, and the left parietal lobe; hypointense on T1-weighted images, hyperintense on T2-weighted images and fluid-attenuated inversion recovery weighted images, DWI with restricted diffusion, and a parietal ring-enhancing lesion after IV gadolinium administration. Discussion. In HIV positive patients, the demyelinating disorders have a broader clinical spectrum that could be explained by the immunosuppressed state of the patients, the evolution of the disease, the use of medications, the opportunistic infections, and the environment. Due to this highly variable clinical spectrum, ADEM is a significant challenge for the physicians in HIV positive patients, causing a delay in the diagnosis and treatment. Conclusion. We suggest that ADEM should be considered among the differential diagnosis in HIV-infected patients with focal or multifocal neurological symptoms, particularly in encephalopathies with multifocal central nervous system involvement without severe immunosuppression.

Post-Infectious Autoimmunity in the Central (CNS) and Peripheral (PNS) Nervous Systems: An African Perspective

“…It usually follows a monophasic course. However, multiphasic, or recurrent ADEM, as well as atypical neuroimaging manifestations have been documented in PLHIV (87,88). Other autoimmune neurological diseases have been documented in PLHIV including myasthenia gravis, N-methyl-D-aspartate-receptor antibody encephalitis, HIV-associated opsoclonus-myoclonus-ataxia syndrome, and neuromyelitis optica with or without detectable anti-aquaporin-4 autoantibodies (89)(90)(91)(92).…”

Clinical and MRI differential analysis of autoimmune encephalitis and viral encephalitis

“… 9 It is believed that patients with acute disseminated encephalomyelitis (ADEM) are diagnosed with VE. Nevertheless, ADEM is a rare disease, with an annual incidence of 0.2–0.8/100,000 10 , 11 ; 80% of cases occur in children under 10 years of age, 12 and 70–93% of patients have a history of infection or vaccination weeks before onset. Because the probability is very small, misdiagnosis can be ruled out.…”

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and Human Immunodeficiency virus infection: dilemmas in diagnosis and management: a case series

“…These atypical presentations of MOGAD in patients with significant immunocompromise raises the possibility of immune dysregulation from HIV infection [ 23 , 24 ]. Moreover, atypical presentations of both ADEM and NMOSD in HIV positive patients have been reported and immune dysregulation is thought to play a role [ 23 – 25 ]. Although speculative, MOGAD may have been a possible explanation for those ADEM or NMOSD-seronegative cases with atypical presentations prior to widespread availability of MOG antibody testing.…”