HIV seroconversion manifesting as Guillian-Barre syndrome

• DOI: 10.3760/cma.j.issn.0366-6999.20131338
• Publication Date: 2024-01-16T18:05:58Z
• Authors: Ankur Nandan Vars...; Ravi Anand; Annesh Bhattacharjee; Prasad Pratibha; Nilesh Kumar; N. K. Singh
• Keywords: myalgia; Neurological examination; Seroconversion; Sore throat; Past medical history; Cranial nerves

To the editor: Human immunodeficiency virus (HIV) infection is an epidemic of modern era. Primary HIV usually presents as fever, fatigue, lymphadenopathy, myalgia, nausea and diarrhoea. Neurological symptoms may present during primary in 9% patients aseptic meningitis or opportunistic infections. The occurrence Guillian-Barre syndrome (GBS) seroconversion rare.1 We report a case patient who presented with acute onset quadriparesis diagnosed inflammatory demyelinating polyneuropathy simultaneous positive previous negative status. A 48-year-old farmer complaint tingling paraesthesias lower limbs since last 4 days. disease started from bilateral initially inability to stand later progressed involve upper form unable comb hairs. There was no history trauma, weight loss, back root pain, weakness cranial/bulbar muscles, bowel/bladder involvement any proceeding respiratory/gastrointestinal infection. blood donation one month which his status negative. Later he accepted sexual promiscuity. His vitals were within normal limits. On neurologic examination, higher mental function cranial nerves normal. motor there symmetrical muscles both (Grade 1/5) along bulk, hypotonia, absent reflexes plantar reflex. Findings similar except power 2/5. Objective sensory deficit not demonstrable. Examination other systems essentially In view clinical presentation, provisional diagnosis GBS made. Cerebrospinal fluid (CSF) analysis revealed CSF protein 74 mg/dl mononuclear pleocytosis (25 cells/mm3, lymphocyte-100%). subjected testing for HIV-I by enzyme-linked immunosorbent assay confirmed Western Blotting test. CD4 count 400/mm3. Electro-diagnostic studies slowing conduction velocity block limbs, reflecting demyelination. Diagnosis arrived HIV-related GBS. treated IVimmunoglobulins at dose 0.4 g·kg-1·day-1. By fifth day treatment slight improvement limb strength. predominant neuropathy that starting then progresses respiratory muscles.2 Though it less prevalent when compared distal antiretroviral toxic neuropathies, occur seroconversion.3 history, physical course nerve resemble those seronegative patients.4 concentration raised but can up 50 cells per μl should raise suspicion HIV. form, mainly consist CD8+ lymphocytes, appears be more frequent than axonal form. preserved depleted GBS.3 Both plasmapheresis intravenous immunoglobulin have been used successfully treat infected individuals.5