1 - Unidade de Infecciologia, Área da Criança, Adolescente e Mulher, Hospital Dona Estefânia, CHLC
2 - Departamento de Neurorradiologia, CHLC
3 - Unidade de Neurologia, Área da Criança, Adolescente e Mulher, Hospital Dona Estefânia, CHLC
- 36th Annual Meeting oftheEuropeanSociety for PaediatricInfectiousDiseases, Malmo, Sweden, 28 de maio a 2 de junho de 2018, sob a forma de comunicação oral na sessão “Meetthe Professor” e poster
Resumo:
Introdução: HIV encephalopathy is the most common neurologic manifestation of HIV infection in children and can be its presenting feature, namely as spastic tetraplegia. Neurodevelopment impairment in HIV-infected children is still common, especially in non-treated children.
Relato de caso: A previously healthy 8-year-old boy was referred to our institution with a 2-year history of motor and cognitive regression. He first presented dysarthria and subsequently a gait disturbance and bladder and bowel incontinence. He had weight loss and numerous molluscumcontagiosum lesions. Neurologic examination was remarkable for dysarthria, muscular atrophy and spastic paraparesis with brisk and spreading stretch reflexes, especially on the right side, bilateral extension plantar responses and extinguishable clonus. MRI revealed cortico-subcortical, cerebellar and brainstem atrophy, with prominent ventricles and sulcii, and multifocal white matter lesions which, together with the clinical picture, were suggestive of HIV infection, which was confirmed by serologic testing, viral load was 174456 copies/mL with 148 CD4/mL, CSF viral load was 193258 copies/mL. Antiretroviral therapy (ART) was started and eighteen months later, with an undetectable viral load and 836 CD4/mL, the patient had a better school performance and recovered some motor skills. MRI was repeated at this time and showed a notorious improvement.
Conclusões: This presentation of both spastic paraparesis and pseudobulbar palsy was common in the pre-highly active ART era, and is probably associated with the late diagnosis in this child. ART seems to have a good impact on this disease. Contrary to what happens in adults with HIV encephalopathy, ART seems to have a good impact on the disease with radiological regression and good prognosis.
Palavras Chave: Encephalopathy; HIV