HIV encephalopathy masquerading as infantile stroke syndrome: Treatment after antiretroviral did wonders

Abstract

We present a case report of a young child with fever for 2 weeks followed by ataxia, spastic quadriparesis, aphasia with bulbar palsy, and lastly loss of consciousness. All symptoms developed within a span of 5 days. Provisional diagnosis of infantile stroke due to infective vasculitis was made. Cranial computed tomography revealed multiple infarctions with bilateral dilated ventricles and mild cortical atrophy. Based on cerebrospinal fluid analysis, contact history and Mantoux test, anti-tubercular therapy was started. Therapeutic failure led to a suspicion of immunosuppression. So, opportunistic infections of central nervous system along with neurotuberculosis were ruled out by relevant standard tests. Subsequently human immunodeficiency virus encephalopathy was diagnosed and highly active antiretroviral therapy was initiated immediately. Neurological abnormalities reversed and complete radiological clearance was noted with highly active antiretroviral therapy within 1 year. The unusual presentation, rare neuroimaging findings, and dramatic response make this case notable.