Wuliji Natalia, Mandell Matthew J, Lunt Jason M, Merando Adam
Internal Medicine Residency Training Program, Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, MO, USA.
Internal Medicine Residency Program at University of Illinois at Chicago/Advocate Christ Medical Center, Oak Lawn, IL, USA.
Case Rep Infect Dis. 2019 Sep 15;2019:3842425. doi: 10.1155/2019/3842425. eCollection 2019.
HIV-associated vacuolar myelopathy (HIV-VM) is the most common cause of spinal disease in HIV/AIDS. HIV-VM causes progressive spastic paraparesis, sensory ataxia, and autonomic dysfunction. It is a progressive myelopathy that shares features with subacute combined degeneration seen in vitamin B12 deficiency as well as other neurological diseases and can occur synchronously with HIV-associated dementia (HAD). Here, we describe a rare case in which a patient's initial presentation of HIV/AIDS was both HIV-VM and HAD. A fifty-three-year-old man presented with a six-month history of numerous falls due to progressive gait instability with associated memory loss, tremor, urinary retention, and impotence. His exam was significant for hyperreflexia and weakness in bilateral lower extremities, upgoing plantar reflex, dysmetria, and ataxic gait. MRI-brain was notable for nonspecific volume loss and diffusely increased T2 signal throughout the supratentorial white matter. Lumbar puncture showed isolated lymphocytic pleocytosis with all other CSF testing unremarkable. He ultimately tested positive for HIV-1, with a CD4 count of 157 cells/mm and a viral load of 874,000 copies/mL. He was diagnosed with HIV-VM and HAD which improved after several months of antiretroviral therapy. This case highlights the importance of considering HIV testing in a patient with a sensory neuropathy and/or progressive cognitive impairment.
人类免疫缺陷病毒相关空泡性脊髓病（HIV-VM）是HIV/AIDS患者脊髓疾病最常见的病因。HIV-VM可导致进行性痉挛性截瘫、感觉性共济失调和自主神经功能障碍。它是一种进行性脊髓病，与维生素B12缺乏所致的亚急性联合变性以及其他神经系统疾病具有共同特征，并且可与HIV相关痴呆（HAD）同时发生。在此，我们描述了一例罕见病例，该患者最初表现为同时患有HIV-VM和HAD的HIV/AIDS。一名53岁男性因进行性步态不稳伴记忆力减退、震颤、尿潴留和阳痿，出现了6个月内多次跌倒的病史。他的检查结果显示双侧下肢反射亢进和无力、巴宾斯基征阳性、辨距不良和共济失调步态。脑部MRI显示非特异性体积缩小以及幕上白质T2信号弥漫性增加。腰椎穿刺显示单纯淋巴细胞增多，其他脑脊液检查均无异常。他最终HIV-1检测呈阳性，CD4细胞计数为157个/mm，病毒载量为874,000拷贝/mL。他被诊断为HIV-VM和HAD，在接受了几个月的抗逆转录病毒治疗后病情有所改善。该病例强调了对于患有感觉性神经病变和/或进行性认知障碍的患者进行HIV检测的重要性。
