A Case of Severe Progres sion of HIV-1 Meningoencephalitis and Lues Secundaria

Česká verzia

Authors: M. Zlámal ¹; P. Smejkal ¹; T. Tyll ²; R. Havlíček ³; P. Navrátil ⁴; M. Holub ¹
Authors place of work: Klinika infekčních nemocí 1. LF UK a ÚVN Praha ¹; Klinika anesteziologie, resuscitace a intenzivní medicíny 1. LF UK a ÚVN Praha ²; Neurologické oddělení, ÚVN Praha ³; Psychiatrické oddělení, ÚVN Praha ⁴
Published in the journal: Cesk Slov Neurol N 2016; 79/112(6): 703-706
Category: Case Report

Summary

Acute meningoencephalitis manifesting itself within weeks to months after infection with the human immunodeficiency virus (HIV) and may have severe course. We present an uncommon case of a 40-year-old male newly diagnosed with acute HIV infection and secondary syphilis after he was examined for fever and hepatorenal failure. Two days after the patient was informed about his HIV and syphilis diagnosis he developed hyperventilation, seizures and coma for which he had to be intubated. The reaction raised suspicion of an ongoing acute neuroinfection. Subsequent cerebrospinal fluid analysis revealed mild lymphocytic pleocytosis and high level of HIV-1 RNA leading to diagnosis of HIV-1 meningoencephalitis. Absence of intrathecal synthesis of antitreponemal antibodies excluded neurosyphilis. Treatment with a combination of antiretroviral therapy, neurological and psychiatric medication and supportive psychotherapy led to significant improvement of patient’s neuropsychological condition. In addition, therapy with betalactam antibiotics cured syphilis and resulted in normalization of liver and renal functions. To our knowledge, no case study of severe HIV-1 meningoencephalitis with concomitant complicated secondary syphilis with hepatorenal failure has thus far been reported in the literature.

Key words:
HIV-1 meningoencephalitis – secondary syphilis – life-threatening affective reaction – hepatorenal failure – combination antiretroviral therapy – multidisciplinary care

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

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