P-PN033. Chronic inflammatory demyelinating polyneuropathy in HIV infected patient responding to plasmapheresis: A case report

Abstract

Introduction . Chronic Inflammatory Demyelinating Polyradiculoneuropathy or CIDP is a neurological disorder characterized by chronic progressive weakness and impairment of sensory function of the limbs and arms, accompanied by decreased tendon reflexes. CIDP can occur in the setting of HIV, as are other immune-mediated neurologic disorders including a wide spectrum of neuropathies. Results . Male, 27 years old, with thick and tingling complaints in both feet and hands followed by ascending, symmetrical, progressive weakness of all four limbs for 3 months. Physical examination showed decreased muscle strength, areflexia, and hypoesthesia in the distal four extremities. In addition, there was oral candidiasis in the patient so there was a suspicion of an immunodeficiency condition. Repeat HIV antibody testing returned positive. The ENMG results shows demyelinating and axonopathy in peripheral nerve. Six sessions of plasmapheresis measures were performed in this patient as therapy. Muscle strength and complaints of numbness improved with therapy, patient was expected to continue to improve with intensive rehabilitation after discharge. The diagnosis of CIDP meets the EFNS clinical criteria and EFNS definite electrophysiologic criteria. This case can be distinguished from HIV-related distal sensory polyneuropathy because of motor nerve involvement. Conclusion . CIDP may occur in early stages of HIV infection, is probably autoimmune in etiology, clinically shows sensorimotor neuropathy and nerve conduction studies show demyelination. This case report shows HIV-infected patients with CIDP displayed a progressive course of sensorimotor involvement. Plasma exchange showed a good therapeutic response in this case.