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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

Computed Tomography head with contrast. Computed Tomography head with contrast showing multiple ring enhancing lesions with surrounding oedema (see arrows)
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Fig2: Computed Tomography head with contrast. Computed Tomography head with contrast showing multiple ring enhancing lesions with surrounding oedema (see arrows)

Mentions: On day 2 of admission the non-contrast CT head report was revised as being suggestive of metastatic lesions with surrounding oedema, raising the possibility of cerebral metastases. It was noted that the hypodensities on the non-contrast CT head demonstrated cortical sparing and were not wedge shaped, suggesting against multiple lacunar infarcts. A CT-chest, abdomen and pelvis and a CT head with contrast were requested for staging of the presumed tumour, and dexamethasone was started for presumed symptomatic cerebral metastases with oedema. Due to patient confusion, this imaging was only obtained whilst anaesthetised on day 6 of admission. The CT head with contrast (see Fig. 2) showed the aforementioned hypodensities to be multiple ring enhancing lesions with surrounding oedema; additional lesions were noted in the brainstem, and the largest lesion was in the right frontal lobe measuring 22 mm in diameter. It was reported that appearances were consistent with disseminated brain metastases but that intracerebral tuberculomas could give a similar appearance. The CT-chest, abdomen and pelvis showed left upper lobe consolidation suggestive of infection, with no evidence of metastases, primary tumour or adenopathy. Blood tests for tumour markers alpha-fetoprotein, cancer antigen 19–9 (CA19-9), carcinoembryonic antigen (CEA) and prostate specific antigen (PSA) were all within normal limits. Prophylactic levetiracetam was started.Fig. 2


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

Stefaniak J - BMC Neurol (2015)

Computed Tomography head with contrast. Computed Tomography head with contrast showing multiple ring enhancing lesions with surrounding oedema (see arrows)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig2: Computed Tomography head with contrast. Computed Tomography head with contrast showing multiple ring enhancing lesions with surrounding oedema (see arrows)
Mentions: On day 2 of admission the non-contrast CT head report was revised as being suggestive of metastatic lesions with surrounding oedema, raising the possibility of cerebral metastases. It was noted that the hypodensities on the non-contrast CT head demonstrated cortical sparing and were not wedge shaped, suggesting against multiple lacunar infarcts. A CT-chest, abdomen and pelvis and a CT head with contrast were requested for staging of the presumed tumour, and dexamethasone was started for presumed symptomatic cerebral metastases with oedema. Due to patient confusion, this imaging was only obtained whilst anaesthetised on day 6 of admission. The CT head with contrast (see Fig. 2) showed the aforementioned hypodensities to be multiple ring enhancing lesions with surrounding oedema; additional lesions were noted in the brainstem, and the largest lesion was in the right frontal lobe measuring 22 mm in diameter. It was reported that appearances were consistent with disseminated brain metastases but that intracerebral tuberculomas could give a similar appearance. The CT-chest, abdomen and pelvis showed left upper lobe consolidation suggestive of infection, with no evidence of metastases, primary tumour or adenopathy. Blood tests for tumour markers alpha-fetoprotein, cancer antigen 19–9 (CA19-9), carcinoembryonic antigen (CEA) and prostate specific antigen (PSA) were all within normal limits. Prophylactic levetiracetam was started.Fig. 2

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