P.029 Case report: Facial diplegia and aseptic meningitis in a 44 year-old man returning from Côte d’Ivoire

Abstract

Background: Bilateral facial paralysis is a rare manifestation of Human Immunodeficiency Virus (HIV). Few cases of HIV seroconversion syndrome presenting with aseptic meningitis and facial diplegia have been previously reported. Methods: Case Report. Case Description: A 44-year-old male with uncontrolled hypertension who presented with 5-day history of migrainous headache, bucco-labial dysarthria, meningismus and dysguesia. Three weeks prior to presentation, he suffered a transient febrile illness preceded by an unprotected sexual encounter while vacationing in Côte d’Ivoire. Examination was significant for hypertensive urgency, bilateral lower motor neuron (LMN) facial paralysis, and meningeal irritation. Investigations revealed acute on chronic renal impairment and left ventricular hypertrophy. Brain MRI (without contrast) revealed microhemorrhages with dystrophic calcifications and microangiopathic changes. CSF analysis revealed 55 WBC (lymphocytic), normal glucose, and 0.67g/L protein. The infectious work-up was positive for HIV, which was confirmed by Western Blot (WB). CD4 count was 176 cells/μL and the viral load was 419,289 copies/ml. Lyme antibodies were also positive by enzyme-linked immunosorbent assay (ELISA), but negative by WB. Discussion: Facial diplegia is a rare manifestation of HIV, and can be indicative of a seroconversion syndrome. This case illustrates another layer of complexity; deciphering acute from chronic systemic manifestations of hypertension, and appreciating falsely positive Lyme antibodies by ELISA during acute HIV seroconversion.