Atypical HIV-Vacuolar Myelopathy. Case Report and Literature Review.

Abstract

Background: Here, we report an atypical presentation of HIV-vacuolar myelopathy and search the available medical literature about atypical presentations of human immunodeficiency virus associate vacuolar myelopathy (HIVVM) and immunoglobulin therapy response.Case: A 26-year-old lady who was four 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, ARV's, 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, no responding to the treatment, including intravenous immunoglobulin.