Cabaraux Pierre, Poncelet Arthur, Honnorat Jérome, Demeester Remy, Cherifi Soraya, Manto Mario
Unité des Ataxies Cérébelleuses, Service de Neurologie, Centre Hospitalier Universitaire (CHU)-Charleroi, Charleroi, Belgium.
Service de Médecine Interne, Centre Hospitalier Universitaire (CHU)-Charleroi, Charleroi, Belgium.
Front Neurol. 2020 Nov 23;11:585527. doi: 10.3389/fneur.2020.585527. eCollection 2020.
Human immunodeficiency viruses (HIV) infection is associated with a broad range of neurological manifestations, including opsoclonus-myoclonus ataxia syndrome (OMAS) occurring in primary infection, immune reconstitution syndrome or in case of opportunistic co-infection. We report the exceptional case of a 43-year-old female under HIV treatment for 10 years who presented initially with suspected epileptic seizure. Although the clinical picture slightly improved under anti-epileptic treatment, it was rapidly attributed to OMAS. The patient exhibited marked opsoclonus, mild dysarthria, upper limbs intermittent myoclonus, ataxia in 4 limbs, truncal ataxia, and a severe gait ataxia (SARA score: 34). The diagnostic work-up showed radiological and biological signs of central nervous system (CNS) inflammation and cerebral venous sinus thromboses. The HIV viral load was higher in cerebrospinal fluid (CSF) than in the blood (4,560 copies/ml vs. 76 copies/ml). She was treated for 5 days with pulsed corticotherapy. Dolutegravir and anticoagulation administration were initiated. Follow-ups at 2 and 4 months showed a dramatic improvement of clinical neurologic status (SARA score at 4 months: 1), reduction of CNS inflammation and revealed undetectable CSF and serum viral loads. This case underlines the importance of the evaluation of the CSF viral load in HIV patients developing OMAS and suggests CSF HIV RNA escape as a novel cause for OMAS.
人类免疫缺陷病毒（HIV）感染与多种神经系统表现相关，包括在初次感染、免疫重建综合征或机会性合并感染时出现的眼阵挛-肌阵挛共济失调综合征（OMAS）。我们报告了一例特殊病例，一名43岁女性接受HIV治疗10年，最初表现为疑似癫痫发作。尽管在抗癫痫治疗下临床症状略有改善，但很快被归因于OMAS。患者表现出明显的眼阵挛、轻度构音障碍、上肢间歇性肌阵挛、四肢共济失调、躯干共济失调和严重步态共济失调（SARA评分：34）。诊断检查显示中枢神经系统（CNS）炎症和脑静脉窦血栓形成的影像学和生物学迹象。脑脊液（CSF）中的HIV病毒载量高于血液（4,560拷贝/毫升对76拷贝/毫升）。她接受了5天的脉冲皮质激素治疗。开始使用多替拉韦和抗凝治疗。2个月和4个月的随访显示临床神经状态显著改善（4个月时SARA评分：1），CNS炎症减轻，脑脊液和血清病毒载量检测不到。该病例强调了在发生OMAS的HIV患者中评估脑脊液病毒载量的重要性，并提示脑脊液HIV RNA逃逸是OMAS的一个新病因。
