Session Information
Session Title: AA 2022 Posters - Neurological Rehabilitation
Session Time: None. Available on demand.
Disclosures: Fareea Khaliq, MD: No financial relationships or conflicts of interest
Case Diagnosis: Acute motor and sensory axonal neuropathy (AMSAN) variant of acute inflammatory demyelinating polyneuropathy (AIDP).
Case Description or Program Description: A 37-year-old female with newly diagnosed HIV on HAART developed ascending lower extremity weakness and paresthesias one week after hospitalization for acute liver failure from alcohol abuse. All neurologic workup was negative including imaging studies, vitamin levels, viral PCR and blood work. She had a normal CD4 count and undetectable viral load. Given her hepatic encephalopathy, the weakness was attributed to poor effort and electrodiagnostic testing was deferred. At the time, she required moderate to maximal assistance with ADLs and mobility and was sent to an inpatient rehabilitation (IPR) facility.
Setting: Spinal cord injury unit at IPR facility
Assessment/Results: Given her poor progression at IPR, neurology was consulted. Electrodiagnostic evaluation of bilateral lower extremities and right upper extremity revealed axonal sensorimotor polyneuropathy. She underwent 5 days of IVIG treatment and had mild improvement in manual muscle strength testing and was discharged home as a wheelchair user.
Discussion (relevance): AIDP has been associated with recently diagnosed HIV patients within six months of HAART treatment due to the immune reconstitution inflammatory syndrome causing a state of hyperinflammatory response. However, the AMSAN variant of AIDP is a much rarer condition found in HIV patients causing a decrease in functionality and independence.
Conclusions: Given the rarity of the AMSAN variant in an HIV patient, clinicians need to conduct a timely and thorough investigation and be cognizant of the association between newly diagnosed HIV and symptoms of possible AIDP. This allows a prompt workup to rule out more common causes of AIDP in the HIV-positive patient. Furthermore, rapid analysis will improve overall treatment to preserve function and regain muscle strength in these patients resulting in improved outcomes.
Level of Evidence: Level I
To cite this abstract in AMA style:
Khaliq F, Yan AZ, McCarty E, Schultze W. Complicated Presentation of Rare, HIV Associated AIDP Variant: A Story of Diagnosis [abstract]. PM R. 2022; 14(S1)(suppl 1). https://pmrjabstracts.org/abstract/complicated-presentation-of-rare-hiv-associated-aidp-variant-a-story-of-diagnosis/. Accessed November 21, 2024.« Back to AAPM&R Annual Assembly 2022
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/complicated-presentation-of-rare-hiv-associated-aidp-variant-a-story-of-diagnosis/