1- Unidade de Infecciologia, Área da Criança, Adolescente e Mulher, Hospital Dona Estefânia, CHLC
2- Departamento de Neurorradiologia, CHLC
3- Unidade de Neurologia, Área da Criança, Adolescente e Mulher, Hospital Dona Estefânia, CHLC
Artigo aceite para publicação na revista Neurologia
HIV encephalopathy is the most common neurologic manifestation of HIV infection in children and can be its presenting feature, namely as spastic tetraplegia.
Relato de caso
Eight-year-old African boy with a progressive motor and cognitive regression: dysarthria, gait disturbance, and urinary/faecal incontinence. Physical exam showed muscular atrophy, spastic paraparesis with pyramidal tract signs. Magnetic Resonance Imaging (MRI) revealed corticosubcortical, cerebellar and brainstem atrophy, prominent ventricles and sulcii, multifocal white matter lesions and spinal cord atrophy mainly in posterior and lateral columns, suggesting HIV infection, confirmed by serologic testing in child and mother. The child’s viral load was 174456 copies/mL, with 148 CD4/mL. Cerebrospinal fluid viral load was 193258 copies/mL, negative for opportunistic agents. Vitamin B12 serum level was normal and antibody testing for human T cell lymphotropic virus type 1 (HTLV1) was negative. Eighteen months after beginning of antiretrovirals (ART), the patient had a better school performance, recovered some motor skills, had an undetectable viral load and 836 CD4/mL. MRI showed major improvement.
Spastic tetraplegia or cognitive impairment can be the presenting feature of HIV infection.This late presentation resembles the adult HIV-associated neurocognitive disorder, seen in late-stage disease contrasting with the typical earlier catastrophic form of HIV encephalopathy.Our patient also had changes suggesting HIV myelopathy, a late finding described in adults, usually with cervical and dorsal spinal cord atrophy and T2 hypersignal in the posterior and lateral columns.Here, the pyramidal signs in lower limbs and particularly bladder and bowel dysfunction are also likely to be related to myelopathy in addition to encephalopathy, and there are imaging signs of myelopathy, for which other causes were reasonably excluded. The clinical features of neurological HIV infection in children are uniformly thought to be secondary to brain disease, and MRI findings compatible with myelopathy were never reported before.
Palavras Chave: Encephalopathy;HIV; myelopathy