IRIS manifesting as chronic inflammatory demyelinating polyneuropathy in HIV
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POSTER PRESENTATION Open Access IRIS manifesting as chronic inflammatory demyelinating polyneuropathy in HIV Aravind Reghukumar 1* , Athul Gurudas 1 , VS Kiran Kumar 1 , Ranjani Ravi 2 From 2nd International Science Symposium on HIV and Infectious Diseases (HIV SCIENCE 2014) Chennai, India. 30 January - 1 February 2014 Background CIDP manifesting as part of immune response inflam- matory syndrome (IRIS) in HIV has not been reported till date. Case report 45 year old female was diagnosed to have HIV with a CD4 count of 86. At the time of diagnosis, she was very much emaciated with a BMI of 16, had oral candidiasis and sensory neuropathy with numbness upto both ankles. After ruling out other opportunistic infections, she was started on tenofovir, lamivudine and nevirapine. Three months later, she presented to us with difficulty in walking and dribbling of saliva. History was suggestive of gradual worsening of peripheral neuropathy and pro- gressive ascending limb weakness after initiation of anti retroviral therapy. Bowel and bladder involvement were not present. Clinical examination revealed areflexic quad- riparesis with bilateral LMN facial palsy. Evidence of both small and large fiber neuropathy was present in both upper and lower limbs. Digital clawing was noted in both upper limbs in both ulnar and median nerve dis- tribution. CSF study was suggestive of lymphocytic pleo- cytosis with mild protein elevation. MRI brain and spine were normal. Electromyographic nerve Sconduction stu- dies were consistent with a primary demyelinating poly- neuropathy involving all nerves in upper and lower limbs. CSF PCR for Cytomegalovirus, Ebstein barr virus, herpes and mycobacterium tuberculosis were negative. Since duration of symptoms was more than 2 months, a diagnosis of CIDP was made. She was given inj methyl- prednisolone 1 gm for 5 days followed by tapering doses of prednisolone. There was dramatic improvement in muscle power after initiation of steroids and after 2 weeks she was able to walk without support, facial palsy and digital clawing had recovered. Conclusion The probable explanation is that CIDP in this case occurred as IRIS as evidenced by the improved BMI (19) and CD4 count (170) at the time of presentation. Authors’ details 1 Department of Infectious Diseases, Medical College Hospital, Thiruvananthapuram, India. 2 Cosmopolitan Hospital, Thiruvananthapuram, India. Published: 27 May 2014 doi:10.1186/1471-2334-14-S3-P72 Cite this article as: Reghukumar et al.: IRIS manifesting as chronic inflammatory demyelinating polyneuropathy in HIV. BMC Infectious Diseases 2014 14(Suppl 3):P72. Submit your next manuscript to BioMed Central and take full advantage of: • Convenient online submission • Thorough peer review • No space constraints or color figure charges • Immediate publication on acceptance • Inclusion in PubMed, CAS, Scopus and Google Scholar • Research which is freely available for redistribution Submit your manuscript at www.biomedcentral.com/submit * Correspondence: [email protected] 1 Department of Infectious Diseases, Medical College Hospital, Thiruvananthapuram, India Full list of author information is available at the end of the article Reghukumar et al. BMC Infectious Diseases 2014, 14(Suppl 3):P72 http://www.biomedcentral.com/1471-2334/14/S3/P72 © 2014 Reghukumar et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Transcript of IRIS manifesting as chronic inflammatory demyelinating polyneuropathy in HIV
POSTER PRESENTATION Open Access
IRIS manifesting as chronic inflammatorydemyelinating polyneuropathy in HIVAravind Reghukumar1*, Athul Gurudas1, VS Kiran Kumar1, Ranjani Ravi2
From 2nd International Science Symposium on HIV and Infectious Diseases (HIV SCIENCE 2014)Chennai, India. 30 January - 1 February 2014
BackgroundCIDP manifesting as part of immune response inflam-matory syndrome (IRIS) in HIV has not been reportedtill date.
Case report45 year old female was diagnosed to have HIV with aCD4 count of 86. At the time of diagnosis, she was verymuch emaciated with a BMI of 16, had oral candidiasisand sensory neuropathy with numbness upto bothankles. After ruling out other opportunistic infections,she was started on tenofovir, lamivudine and nevirapine.Three months later, she presented to us with difficultyin walking and dribbling of saliva. History was suggestiveof gradual worsening of peripheral neuropathy and pro-gressive ascending limb weakness after initiation of antiretroviral therapy. Bowel and bladder involvement werenot present. Clinical examination revealed areflexic quad-riparesis with bilateral LMN facial palsy. Evidence ofboth small and large fiber neuropathy was present inboth upper and lower limbs. Digital clawing was notedin both upper limbs in both ulnar and median nerve dis-tribution. CSF study was suggestive of lymphocytic pleo-cytosis with mild protein elevation. MRI brain and spinewere normal. Electromyographic nerve Sconduction stu-dies were consistent with a primary demyelinating poly-neuropathy involving all nerves in upper and lowerlimbs. CSF PCR for Cytomegalovirus, Ebstein barr virus,herpes and mycobacterium tuberculosis were negative.Since duration of symptoms was more than 2 months, adiagnosis of CIDP was made. She was given inj methyl-prednisolone 1 gm for 5 days followed by tapering dosesof prednisolone. There was dramatic improvement in
muscle power after initiation of steroids and after 2 weeksshe was able to walk without support, facial palsy anddigital clawing had recovered.
ConclusionThe probable explanation is that CIDP in this caseoccurred as IRIS as evidenced by the improved BMI(19) and CD4 count (170) at the time of presentation.
Authors’ details1Department of Infectious Diseases, Medical College Hospital,Thiruvananthapuram, India. 2Cosmopolitan Hospital, Thiruvananthapuram,India.
Published: 27 May 2014
doi:10.1186/1471-2334-14-S3-P72Cite this article as: Reghukumar et al.: IRIS manifesting as chronicinflammatory demyelinating polyneuropathy in HIV. BMC InfectiousDiseases 2014 14(Suppl 3):P72.
Submit your next manuscript to BioMed Centraland take full advantage of:
• Convenient online submission
• Thorough peer review
• No space constraints or color figure charges
• Immediate publication on acceptance
• Inclusion in PubMed, CAS, Scopus and Google Scholar
• Research which is freely available for redistribution
Submit your manuscript at www.biomedcentral.com/submit
* Correspondence: [email protected] of Infectious Diseases, Medical College Hospital,Thiruvananthapuram, IndiaFull list of author information is available at the end of the article
Reghukumar et al. BMC Infectious Diseases 2014, 14(Suppl 3):P72http://www.biomedcentral.com/1471-2334/14/S3/P72
© 2014 Reghukumar et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the CreativeCommons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, andreproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
