Paraparesis in a patient with advanced HIV disease without manifestations of opportunistic infection

Abstract

HIV infection had been associated with many symptoms and signs but the least expected is paraparesis in the absence of constitutional clinical  features. This case presentation is to highlight the unusual presentation of a 43 year old who presented with difficulty in walking due to gradual weakness in his lower limbs (more on right than left) and difficulty in passing urine of 8 months duration. All the common symptoms and signs associated with advanced HIV infection were absent. Urethroscopy and prostate biopsy were done and showed normal findings. Cranial computerised tomography (CT) scan finding was normal, but lumbo-sacral Magnetic Resonance Imaging (MRI) showed degenerative disease suggestive of immunosuppression. HIV screening (Unigold and ELISA) and HIV confirmatory tests were done that showed reactivity to HIV-1 antibody and CD4 count and plasma viral load results were 226 cells/ mm3 and 126,000 copies/ml respectively. The patient was commenced on antiretroviral therapy and paraparesis started resolving.

Keywords: HIV infection, Constitutional symptoms, Urinary obstruction, Immunological  parameters