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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

Diffusion Weighted Image-Magnetic Resonance Image. A Diffusion Weighted Magnetic Resonance Image showing multiple lesions with restricted diffusion (see arrows) consistent with multiple abscesses and developing hydrocephalus
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Fig3: Diffusion Weighted Image-Magnetic Resonance Image. A Diffusion Weighted Magnetic Resonance Image showing multiple lesions with restricted diffusion (see arrows) consistent with multiple abscesses and developing hydrocephalus

Mentions: A Diffusion Weighted Image-Magnetic Resonance Image (DWI-MRI) with contrast was subsequently obtained (see Fig. 3). This showed multiple lesions with restricted diffusion consistent with multiple abscesses and developing hydrocephalus. A HIV test was requested; serology was positive for HIV-1, HIV-1 ribonucleic acid (RNA) was detected on polymerase chain reaction (PCR) and the patient’s CD4 T cell count was 50/mm3. A stereotactic biopsy of the right frontal lobe abscess was performed; PCR of the aspirate demonstrated the presence of Nocardia. PCR on a subsequent Broncho-Alveolar Lavage (BAL) confirmed a diagnosis of pulmonary and cerebral Nocardia. The patient was started on Highly Active Antiretroviral Therapy (HAART) for HIV and cotrimoxazole for pulmonary and cerebral nocardiosis. An External Ventricular Drain (EVD) was inserted due to hydrocephalus; acute bilateral frontal lobe haemorrhages with intraventricular extension on the left were noted on a repeat CT head following neurosurgery. The patient had neurosurgical burr holes and was cared for on a neuro-intensive treatment unit (ITU) for several weeks, but eventually recovered and was discharged. Follow up CT head showed a reduction in size of the previous haematoma, decreased size of abscesses and no hydrocephalus.Fig. 3


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

Stefaniak J - BMC Neurol (2015)

Diffusion Weighted Image-Magnetic Resonance Image. A Diffusion Weighted Magnetic Resonance Image showing multiple lesions with restricted diffusion (see arrows) consistent with multiple abscesses and developing hydrocephalus
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig3: Diffusion Weighted Image-Magnetic Resonance Image. A Diffusion Weighted Magnetic Resonance Image showing multiple lesions with restricted diffusion (see arrows) consistent with multiple abscesses and developing hydrocephalus
Mentions: A Diffusion Weighted Image-Magnetic Resonance Image (DWI-MRI) with contrast was subsequently obtained (see Fig. 3). This showed multiple lesions with restricted diffusion consistent with multiple abscesses and developing hydrocephalus. A HIV test was requested; serology was positive for HIV-1, HIV-1 ribonucleic acid (RNA) was detected on polymerase chain reaction (PCR) and the patient’s CD4 T cell count was 50/mm3. A stereotactic biopsy of the right frontal lobe abscess was performed; PCR of the aspirate demonstrated the presence of Nocardia. PCR on a subsequent Broncho-Alveolar Lavage (BAL) confirmed a diagnosis of pulmonary and cerebral Nocardia. The patient was started on Highly Active Antiretroviral Therapy (HAART) for HIV and cotrimoxazole for pulmonary and cerebral nocardiosis. An External Ventricular Drain (EVD) was inserted due to hydrocephalus; acute bilateral frontal lobe haemorrhages with intraventricular extension on the left were noted on a repeat CT head following neurosurgery. The patient had neurosurgical burr holes and was cared for on a neuro-intensive treatment unit (ITU) for several weeks, but eventually recovered and was discharged. Follow up CT head showed a reduction in size of the previous haematoma, decreased size of abscesses and no hydrocephalus.Fig. 3

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