Autopsy and Case Reports
https://www.autopsyandcasereports.org/article/doi/10.4322/acr.2024.493
Autopsy and Case Reports
Clinical Case Report

A great simulator in clinical practice: mononeuritis multiplex in HIV infection

José Pedro Soares Baima; Beatriz Carneiro Gondim Silva; Vanessa Lopes Vieira; Luiz Pedro Meireles; Milton Hideaki Arai; Angelina Maria Martins Lino

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Abstract

HIV infection is a chameleon, mimicking several diseases. Herein, we report a previously healthy 39-year-old woman who, over 2 months, developed arthritis, weight loss, and confluent multiple mononeuropathy. Extensive laboratory investigation showed positive serology for HIV, with a CD4 count of 100 cells, and necrotizing vasculitis on a nerve biopsy not associated with CMV co-infection, allowing the diagnosis of polyarteritis nodosa-like vasculitis in an HIV-infected patient. Apart from the infection, HIV-related autoimmunity can affect any organ and contribute to the complexity of the clinical presentation of HIV infection.

Keywords

Biopsy, HIV, Mononeuropathies, Vasculitis

References

1 Said G. Infectious neuropathies. Neurol Clin. 2007;25(1):115-37. http://doi.org/10.1016/j.ncl.2006.11.004. PMid:17324723.

2 Beyrer C. A pandemic aniversary: 40 years of HIV/AIDS. Lancet. 2021;397(10290):2142-3. http://doi.org/10.1016/S0140-6736(21)01167-3. PMid:34087110.

3 UNAIDS. Geneva: UNAIDS; 2023 [cited 2023 Apr 22]. Available from: Unaids.org/en

4 Anand P, Kharal GA, Reda H, Venna N. Peripheral neuropathy in Infectious Diseases. Semin Neurol. 2019;39(5):640-50. http://doi.org/10.1055/s-0039-1688995. PMid:31639846.

5 Roszkiewicz J, Smolewska E. Kaleidoscope of autoimmune diseases in HIV infection. Rheumatol Int. 2016;36(11):1481-91. http://doi.org/10.1007/s00296-016-3555-7. PMid:27544391.

6 Vega LE, Espinoza LR. Vasculitides in hiv infection. Curr Rheumatol Rep. 2020;22(10):60. http://doi.org/10.1007/s11926-020-00945-0. PMid:32845496.

7 Gwathmey KG, Tracy JA, Dyck PJB. Peripheral nerve vasculitis: Classification and Disease Associations. Neurol Clin. 2019;37(2):303-33. http://doi.org/10.1016/j.ncl.2019.01.013. PMid:30952411.

8 Ginsberg L. Vasculitis and the peripheral nervous system. Rheumatology (Oxford). 2020;59(Suppl 3):iii55-9. http://doi.org/10.1093/rheumatology/keaa075. PMid:32348511.

9 Morrow MJ. Ischemic optic neuropathy. Continuum (Minneap Minn). 2019;25(5):1215-35. http://doi.org/10.1212/CON.0000000000000767. PMid:31584535.

10 Huang Y-M, Hong X-Z, Xu J-H, Luo JX, Mo HY, Zhao HL. Autoimmunity and dysmetabolism of human acquired immunodeficiency syndrome. Immunol Res. 2016;64(3):641-52. http://doi.org/10.1007/s12026-015-8767-5. PMid:26676359.

11 Quaglia M, Merlotti G, Andrea M, Borgogna C, Cantaluppi V. Viral Infections and Systemic Lupus Erythematosus: New Players in an Old Story. Viruses. 2021;13(2):277. http://doi.org/10.3390/v13020277. PMid:33670195.

12 Patel N, Patel N, Khan T, Patel N, Espinoza L. Hiv infection and clinical spectrum of associated vasculitides. Curr Rheumatol Rep. 2011;13(6):506-12. http://doi.org/10.1007/s11926-011-0214-6. PMid:21989711.

13 Karam C. Peripheral neuropathies associated with vasculitis and autoimmune connective tissue disease. Continuum (Minneap Minn). 2020;26(5):1257-79. http://doi.org/10.1212/01.CON.0000718940.59848.68.

14 Mathis S, Duchesne M, Magy L, Vallat JM. Peripheral nervous system involvement in vasculitis. In Rajabally YA, editor. Dysimmune neuropathies. Cambridge: Academic Press; 2020. p. 145-76. http://doi.org/10.1016/B978-0-12-814572-2.00007-8.

15 Collins MP, Dyck PJ, Gronseth GS, et al. Peripheral Nerve Society Guideline on the classification, diagnosis, investigation, and immunosuppressive therapy of non-systemic vasculitic neuropathy: executive summary. J Peripher Nerv Syst. 2010;15(3):176-84. http://doi.org/10.1111/j.1529-8027.2010.00281.x. PMid:21040139.

16 Van den Bergh PY, van Doorn PA, Hadden RDM, et al. European Academy of Neurology/Peripheral Nerve society guideline on diagnosis and treatment of chronic inflammatory demyelinating polyradiculoneuropathy: Report of a joint Task Force - Second revision. J Peripher Nerv Syst. 2021;26(3):242-68. http://doi.org/10.1111/jns.12455. PMid:34085743.

17 Berini SE, Dyck PJB. The utility of nerve biopsy in carefully selected patients in modern neuromuscular practice. Muscle Nerve. 2019;59(6):635-7. http://doi.org/10.1002/mus.26479. PMid:30927280.
 


Submitted date:
08/05/2023

Accepted date:
04/21/2024

Publication date:
06/14/2024

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