HIV encephalopathy, case report

Abstract

Background: Encephalopathy by human immunodeficiency virus (HIV), was first described in 1986 as AIDS dementia complex. It is common knowledge that the involvement of the central nervous system by HIV occurs at an early stage of infection and is linked with seroconversion. This dementia is known as progressive encephalopathy syndrome associated with HIV and present as cognitive, motor and behavioral changes. Case report: The authors present a case of a male patient of 70 years with no relevant pathological history working and living in Angola since 1996, who came on holidays in Portugal (June 2012) and starts complaining of asthenia, malaise, weight loss and one episode of time–space disorientation. At that time he was treated with vitamin complex, with improvement of symptoms, so he returned to Angola. In January 2013, he returned to Portugal with the same symptomatology, having conducted several diagnostic procedures including cranial computerized tomography which revealed no changes. In February 2013, he resorted to the emergency room with the same symptoms, and presented with time-spatial disorientation on physical examination, and analytically thrombocytopenia of 70000 × 10 E9/L, being admitted to study a demential syndrome. During hospitalization was conducted lumbar puncture, which revealed acellular with mild increase of protein in cerebrospinal fluid, and infection by human immunodeficiency virus (Viral Load 260249alg 5.42 Cells, Cells and CD4-70). No other analytical alterations were found and other viral infections of central nervous system were excluded. He performed a brain MRI that show multiple small nodular areas of hyperintense cortical–subcortical deep and fronto-parietal, attributable to microvascular nature, possibly being the HIV encephalitis. The encephalogram study revealed slow background activity grade II/V. The patient began therapy with acyclovir therapy, anti-retro-viral (emtricitabine, tenofovir, darunavir/ritonavir) and valproic acid, with good clinical response and analytical. In subsequent medical visit, two months after discharge, the patient had been guided in space and time with no other symptoms. Conclusions: The case is presented here because it is an unexpected presentation of HIV infection in a patient 70 years of age.