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HIV/AIDS presenting with stroke-like features caused by cerebral Nocardia abscesses: a case report.

Stefaniak J - BMC Neurol (2015)

Bottom Line: Human Immunodeficiency Virus infection can produce a variety of neurological presentations with the added possibility of multiple pathological processes being present simultaneously.This is only further complicated in instances, such as the present case, when Human Immunodeficiency Virus infection has not yet been diagnosed.It is therefore imperative that appropriate neuroimaging is done at an early stage to ensure timely initiation of appropriate therapy.

View Article: PubMed Central - PubMed

Affiliation: University of Cambridge School of Clinical Medicine, Cambridge, UK. james.stefaniak@nhs.net.

ABSTRACT

Background: Immunosuppression in Human Immunodeficiency Virus can predispose to opportunistic infections of the central nervous system and can be life threatening without early recognition and management. This can be delayed in undiagnosed Human Immunodeficiency Virus. The present article is the only case report in the literature to describe a first presentation of Acquired Immune Deficiency Syndrome as cerebral Nocardia abscesses that were initially treated as a stroke.

Case presentation: A previously well 59 year old Caucasian man presented with sudden onset of left sided hemiparesis and sensory change, right sided headache, diplopia and confusion. The patient was initially treated as a stroke but was eventually found to have pulmonary and cerebral Nocardia abscesses secondary to a new diagnosis of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome.

Conclusion: Human Immunodeficiency Virus infection can produce a variety of neurological presentations with the added possibility of multiple pathological processes being present simultaneously. This is only further complicated in instances, such as the present case, when Human Immunodeficiency Virus infection has not yet been diagnosed. It is therefore imperative that appropriate neuroimaging is done at an early stage to ensure timely initiation of appropriate therapy. Cerebral Nocardia abscesses are a serious and potentially life threatening complication of Human Immunodeficiency Virus.

No MeSH data available.


Related in: MedlinePlus

Non-contrast Computed Tomography head. Non-contrast Computed Tomography head taken on admission showing scattered areas of hypodensity involving grey and white matter in the right basal ganglia, bilateral frontal lobes (see arrow) and bilateral parietal lobes
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Fig1: Non-contrast Computed Tomography head. Non-contrast Computed Tomography head taken on admission showing scattered areas of hypodensity involving grey and white matter in the right basal ganglia, bilateral frontal lobes (see arrow) and bilateral parietal lobes

Mentions: Admission blood results demonstrated a mild macrocytosis (Mean Cell Volume [MCV] 105 fL), neutrophilia (neutrophil count 12 x 109/L), lymphopenia (lymphocyte count 0.39 x 109/L) and hyponatremia (sodium 130 millimolar (mM). An initial non-contrast Computed Tomography (CT) head (see Fig. 1) showed scattered areas of hypodensity involving grey and white matter in the left cerebellar hemisphere, right basal ganglia, bilateral frontal lobes, bilateral parietal lobes and left occipital lobe. Ventricles were undistended and undisplaced, no mass or haemorrhage was seen and the images were reported as being consistent with multiple ischaemic infarcts. The patient was diagnosed as having a stroke with a National Institute of Health Stroke Score (NIHSS) of 3 and started on aspirin, a statin and an angiotensin converting enzyme (ACE) inhibitor.Fig. 1


HIV/AIDS presenting with stroke-like features caused by cerebral Nocardia abscesses: a case report.

Stefaniak J - BMC Neurol (2015)

Non-contrast Computed Tomography head. Non-contrast Computed Tomography head taken on admission showing scattered areas of hypodensity involving grey and white matter in the right basal ganglia, bilateral frontal lobes (see arrow) and bilateral parietal lobes
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4597441&req=5

Fig1: Non-contrast Computed Tomography head. Non-contrast Computed Tomography head taken on admission showing scattered areas of hypodensity involving grey and white matter in the right basal ganglia, bilateral frontal lobes (see arrow) and bilateral parietal lobes
Mentions: Admission blood results demonstrated a mild macrocytosis (Mean Cell Volume [MCV] 105 fL), neutrophilia (neutrophil count 12 x 109/L), lymphopenia (lymphocyte count 0.39 x 109/L) and hyponatremia (sodium 130 millimolar (mM). An initial non-contrast Computed Tomography (CT) head (see Fig. 1) showed scattered areas of hypodensity involving grey and white matter in the left cerebellar hemisphere, right basal ganglia, bilateral frontal lobes, bilateral parietal lobes and left occipital lobe. Ventricles were undistended and undisplaced, no mass or haemorrhage was seen and the images were reported as being consistent with multiple ischaemic infarcts. The patient was diagnosed as having a stroke with a National Institute of Health Stroke Score (NIHSS) of 3 and started on aspirin, a statin and an angiotensin converting enzyme (ACE) inhibitor.Fig. 1

Bottom Line: Human Immunodeficiency Virus infection can produce a variety of neurological presentations with the added possibility of multiple pathological processes being present simultaneously.This is only further complicated in instances, such as the present case, when Human Immunodeficiency Virus infection has not yet been diagnosed.It is therefore imperative that appropriate neuroimaging is done at an early stage to ensure timely initiation of appropriate therapy.

View Article: PubMed Central - PubMed

Affiliation: University of Cambridge School of Clinical Medicine, Cambridge, UK. james.stefaniak@nhs.net.

ABSTRACT

Background: Immunosuppression in Human Immunodeficiency Virus can predispose to opportunistic infections of the central nervous system and can be life threatening without early recognition and management. This can be delayed in undiagnosed Human Immunodeficiency Virus. The present article is the only case report in the literature to describe a first presentation of Acquired Immune Deficiency Syndrome as cerebral Nocardia abscesses that were initially treated as a stroke.

Case presentation: A previously well 59 year old Caucasian man presented with sudden onset of left sided hemiparesis and sensory change, right sided headache, diplopia and confusion. The patient was initially treated as a stroke but was eventually found to have pulmonary and cerebral Nocardia abscesses secondary to a new diagnosis of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome.

Conclusion: Human Immunodeficiency Virus infection can produce a variety of neurological presentations with the added possibility of multiple pathological processes being present simultaneously. This is only further complicated in instances, such as the present case, when Human Immunodeficiency Virus infection has not yet been diagnosed. It is therefore imperative that appropriate neuroimaging is done at an early stage to ensure timely initiation of appropriate therapy. Cerebral Nocardia abscesses are a serious and potentially life threatening complication of Human Immunodeficiency Virus.

No MeSH data available.


Related in: MedlinePlus