Motor Neuron Disease and Acquired Axonal Neuropathy Association in HIV Infection: Case Report and Update

Peter      Salem; Oscar      Arias-Carrion; Sara      L.S. de Menezes; Marcia      W. Cruz; Fabio      H. de Gobbi Porto; Eduardo      Davidovich; Cristiane      Nascimento; Marco      A.A. Leite; Flavio      Sztajnbok; Marco      Orsini; Antonio      E. Nardi; Sergio      Machado; Acary      B. Oliveira; Antonio      M. da Silva Catharino; Carlos      H.M. Reis; Marzia      P. Sohler; Julio      G. Silva; Marcos      R.G. de Freitas

Abstract

Background: A possible viral etiology has been documented in the genesis of motor neuron disorders and acquired peripheral neuropathies, mainly due to the vulnerability of peripheral nerves and the anterior horn to certain viruses. In recent years, several reports show association of HIV infection with Amyotrophic Lateral Sclerosis – Syndrome, Motor Neuron Diseases and peripheral neuropathies.

Objective: To report a case of an association between Motor Neuron Disease and Acquired Axonal neuropathy in HIV infection, and describe the findings of neurological examination, cerebrospinal fluid, neuroimaging and electrophysiology.

Methods: The patient underwent neurological examination. General medical examinations were performed, including, specific neuromuscular tests, analysis of cerebrospinal fluid, muscle biopsy and imaging studies.

Results and Discussion: The initial clinical presentation of our case was marked by cramps and fasciculations with posterior distal paresis and atrophy in the left arm. We found electromyography tracings with deficits in the anterior horn of the spinal cord and peripheral nerves. Dysphagia and release of primitive reflexes were also identified. At the same time, the patient was informed to be HIV positive with high viral load. He received antiretroviral therapy, with load control but with no clinical remission.

Conclusion: Motor Neuron disorders and peripheral neuropathy may occur in association with HIV infection. However, a causal relationship remains uncertain. It is noteworthy that the antiretroviral regimen may be implicated in some cases.

Keywords: Motor neuron disease, HIV infection, acquired neuropathies, HAART, MND, axonal, patients, nerves, disorders, antiretroviral therapy