Disclosures: Jayne Ha, DO: No financial relationships or conflicts of interest

Case Diagnosis: 34-year-old male patient, who presented with sudden onset left facial weakness, truncal ataxia, right upper extremity weakness, is diagnosed with GBS and HIV.

Case Description or Program Description: A 34-year-old male patient with past medical history hypertension, presents with sudden onset left facial weakness, which was followed by truncal ataxia, right upper extremity weakness and bilateral lower extremity weakness within a few hours. Despite the initial suspicions of an acute stroke, patient’s CT head, CTA head and neck, MRI brain, MRI, MRI neck were negative. Patient’s early serial neurology examinations were significant for cranial nerve pathology –absence of palate elevation, weakness of facial muscles and significant weakness of the distal bilateral extremities.

Setting: Acute Inpatient Rehabilitation

Assessment/Results: CVA work up continued to be noncontributory: patient’s transesophageal echocardiogram was negative for abnormalities and hypercoagulability workup (arterial: homocysteine, ESR, CRP, ANA, ds-DNA, c-ANCA, p-ANCA and venous: factor V leiden and prothrombin gene mutations, protein C and S activity, anti-thrombin III activity, mixed: LPA, anti-cardiolipin IgM/IgG, b2-glycoprotein) was also unremarkable. A lumbar puncture was completed, which showed albuminocytologic dissociation (WBC 12, RBC 1, meningitis/encephalitis panel negative, protein elevated at 104, glucose 64). A subsequent EMG/NCS was completed, which showed signs of diffuse axonal neuropathy. With a diagnosis of GBS, the patient underwent IVIG for a total of 5 days and symptoms began to improve within 2 weeks span. Patient’s positive HIV status was revealed in this admission (CD4: 511, viral load: 564,000).

Discussion (relevance): Although cases of GBS have been reported as an initial presentation for newly diagnosed HIV patients, such cases are still quite rare as most GBS patients have an antecedent upper respiratory and gastrointestinal infection. This presentation was also atypical in that weakness was asymmetrical, initially causing suspicion of an acute stroke.

Conclusions: GBS patients may have stroke-like presentation in newly diagnosed HIV patients.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/guillain-barre-as-an-initial-presentation-in-newly-diagnosed-hiv-patient-a-case-report/