Abstract
BackgroundHere, 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.CaseA 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.DiscussionIn 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.KeynotesVacuolar myelopathy, HIV, Immunoglobulin therapy, flaccid tetraplegia, hypokalaemia. Renal failure.
Highlights
We report an atypical Human immunodeficiency virus (HIV)-vacuolar myelopathy and search the available medical literature about atypical presentations of human immunodeficiency virus associate vacuolar myelopathy (HIV-VM) and immunoglobu‐ lin therapy response.Case: A 26-year-old lady who was 4 weeks postpartum presented to us with acute flaccid quadriparesis, with no sen‐ sory level
Materials and methods We searched for publications on HIV-vacuolar myelopathy and intravenous immunoglobulin therapy, in answer to the two research questions listed above using the procedure mentioned below and present our patient
We reviewed the following databases for published studies: Medline EMBASE, Scopus online databases, Google Scholar, Science Direct, Scielo, LILACS, BIREME, and Cochrane library to identify articles evaluating HIV-VM and intravenous immunoglobulin (IVIg) therapy*
Summary
In HIV-VM, there is spinal cord atrophy, which mainly involves the thoracic cord. In our case, this patho‐ logical process affected the spinal cord’s cervical region, leading to flaccid tetraplegia, with high CD4 level, with‐ out response to the treatment, including intravenous immunoglobulin. Keynotes: Vacuolar myelopathy, HIV, Immunoglobulin therapy, flaccid tetraplegia, hypokalaemia.
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