Juvenile amyotrophic lateral sclerosis in 16 years old girl with HIV

Abstract

There has been demonstrated that HIV could induce the induction of Amyotrophic lateral sclerosis (ALS) syndrome. The exact mechanism of pathogenesis is not fully understood and classic ALS and HIV-associated ALS are different in some key aspects. Our patient was a 16 years old girl who presented with progressive speech difficulties, gait disturbance, and upper and lowers limb weakness associated with atrophy, fasciculation, and hyperreflexia. After three months she experienced dysphagia. She had thenar atrophy in both hands and anterior forearms. Babinski’s signs were present bilaterally. There was a pattern of diffuse chronic denervation with fasciculations in the four limbs according to electromyogram (EMG) results. Further tests showed the following findings: Positive HIV serology, a CD4+ count of 290 cells/mm3, and plasma HIV– RNA level was 31000 copies/ml; cerebral spinal fluid (CSF) analysis showing 22 cells/mm3 and protein analysis showing 77 mg/dL. It seems to be sufficient evidence that HIV infection is a potential cause of ALS-like syndrome; however, until knowing the exact pathological mechanism, possible coincidental HIV infection in patients with ALS syndrome should be considered.