Disclosures: Megan A. Ziske: Nothing to disclose

Case Description: Patient was first admitted for difficulty swallowing and intermittent mild R arm tingling for 4 days after removal of a central line placed at previous hospitalization for renal infarction due to hypertension. Esophagram showed no evidence of dysmotility. Dysphagia improved without treatment and he was to be discharged home, however, he started experiencing worsening bilateral upper and lower extremity weakness, tingling and decreased sensation, worse on the right side. On workup, he was found to have a reactive antigen/positive antibody screen for HIV. Neurology was consulted and physical exam findings were consistent with AIDP. EMG/NMS and LP were ordered for further evaluation and confirmation.

Setting: Tertiary care hospital.

Patient: A 33-year-old man experiencing bilateral upper extremity and lower extremity weakness and tingling as well as dysphagia.

Assessment/Results: EMG and NMS were performed on bilateral lower extremities and right upper extremity. Findings were accordant with an axonal sensorimotor peripheral polyneuropathy with no active denervation seen on EMG, consistent with HIV associated neuropathy; however, F waves were absent and there was evidence of mild temporal dispersion and sural sparring, making the findings consistent with an axonal variant of AIDP given patient’s time course of clinical symptoms. LP showed no pleocytosis and mild protein elevation; although not classic findings, these were not unexpected results in the first week of symptom onset of AIDP. Instead of IVIg treatment, which can be prothrombotic, plasmapheresis therapy was chosen for this patient as he was already high risk for stroke and MI after previous history of aortic dissection requiring repair and mechanical AVR. After just 3 of his 5 total sessions of plasmapheresis, patient’s strength began to slowly improve.

Discussion: Few cases of the AIDP variant of Guillain Barre syndrome have been reported in HIV seroconversion.

Conclusion: AIDP is a not well-known, but serious and potentially life-threatening disease process related to HIV seroconversion.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/acute-inflammatory-demyelinating-polyradiculoneuropathy-in-the-setting-of-newly-diagnosed-hiv-infection/