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.…”

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 ].…”