Atypical acute inflammatory demyelinating polyneuropathy in the setting of HIV infection: Report of two cases

Abstract

Acute inflammatory demyelinating polyneuropathy AIDP is an immune mediated disorder that affects the peripheral nerve reflected in myelin damage and sometimes in axonal loss. Upper respiratory infection, gas- trointestinal infection or nonspecific febrile processes are clinical entities that usually precede neurological symptoms represented by progressive weakness of the extremities and attenuation of tendinous reflexes. In the setting of HIV infection AIDP is a peripheral nerve disorder that usually occurs shortly after seroconversion when the CD4 count is higher than 500 cells/µl. It is presumed to be immune mediated, although the offending antibody has not been identified yet. We report two clinical cases of atypical AIDP in the setting of HIV infection: The first with a T lymphocyte CD4 count lower than 100 cells /µl and the second in context of immunologic reconstitution inflammatory syndrome IRIS. Both entities are uncommon phenomena. The patients recovered satisfactorily after receiving intravenous immunoglobulin and temporary cessation of antiretroviral therapy respectively.