Seizures, Confusion, and Strokes in a Patient With AIDS

摘要

A 38-year-old right-handed man with acquired immunodeficiency syndrome (AIDS) on antiretroviral therapy (ART) was evaluated for 4 months of progressively worsening confusion, right-sided weakness and numbness, and seizures. He initially presented with a generalized convulsion. After a brain magnetic resonance imaging (MRJ), he was started on levetiracetam. In the following months he noticed short-term memory loss, occasional periods of disorientation, and emotional lability. Then he noticed weakness and numbness of his right arm and leg as well as intermittent jerking movements and unsteady gait. He had intermittent headaches for 2 years and lost 50 pounds over the past year. He denied fevers, chills, or night sweats. He subsequently underwent MRI of spine and lumbar puncture and was referred to our institution for further evaluation. Human immunodeficiency virus (HIV) infection was diagnosed 5 years prior to presentation. He was initially started on ART after developing pulmonary mycobacterium avium complex with CD4 count nadir of <20 cells/μL. His medications included tenofovir/emtricitabine, raltegravir, and levetiracetam. He was born in Mexico and immigrated to United States about 20 years ago. He previously worked maintaining fountains and denied recreational drug use.