Abstract Details

Title New Onset Refractory Status Epilepticus secondary to HIV CNS Syndrome

Topic Infectious Disease

Presentation(s) P10 - Poster Session 10 (8:00 AM-9:00 AM)

Poster/Presentation
Number 4-001

Background HIV CNS viral escape syndrome can cause memory decline, cognitive impairment, focal neurological deficit, and seizures. However, to our knowledge there are no reports of NORSE in association with HIV CNS viral escape syndrome

Objective To report a unique case of HIV CNS viral escape syndrome presenting with new onset refractory status epilepticus (NORSE) in a controlled HIV patient

Design/Methods A case observation of 47- year- old female with history of controlled HIV presented with NORSE due to HIV CNS escape syndrome

Results A unique case of HIV CNS escape syndrome in a 47-year-old- female with controlled HIV who presented with NORSE, that was seronegative for all the commercially available testing for autoimmune and paraneoplastic encephalitides. EEG captured ongoing seizures despite using multiple anti-epileptics and intravenous sedation. She initially received intravenous methylprednisolone, and IVIG for a presumed autoimmune/paraneoplastic encephalitis. CSF analysis revealed a surprisingly high level of HIV in the CNS (34949 copies/mL) even though serum level was low (134 cells/uL). Brain MRI showed areas of restricted diffusion representing sequalae of prolonged seizures. CT of chest, abdomen and pelvis, as well as pelvic ultrasound were unrevealing for malignancy. Although, the detection of HIV in the CNS led to a change in combination antiviral therapy (cART) with improved CNS penetrance, neurological improvement did not occur. She remained comatose despite being seizure free

Conclusions Our case underscores diverse neurological manifestations of HIV CNS escape syndrome, that should include NORSE, in otherwise well-controlled HIV patients. Early diagnosis of HIV CNS escape syndrome requires a change in cART which can potentially change neurological outcomes. Therefore, HIV CNS escape syndrome should be considered early in the investigation of NORSE in HIV patients

Authors/Disclosures
Mustafa Al-Chalabi, DO PRESENTER	Dr. Al-Chalabi has nothing to disclose.
Jennifer Amsdell, MD (Promedica Neuroscience Center)	Dr. Amsdell has nothing to disclose.
Mehmood Rashid, MD (Neuroscience Center)	Dr. Rashid has nothing to disclose.
Ajaz Sheikh, MD (ProMedica Neurosciences Center)	Dr. Sheikh has nothing to disclose.