Guillain-Barré syndrome spectrum as manifestation of HIV-related immune reconstitution inflammatory syndrome: case report and literature review

Braz J Infect Dis. 2022 May-Jun;26(3):102368. doi: 10.1016/j.bjid.2022.102368. Epub 2022 May 21.

Abstract

A 34-year-old man presented with a history of 21-days of gait unsteadiness and diplopia. Ten days before presentation, he developed limb weakness and in the last three days reduced consciousness. HIV infection was diagnosed three months ago (CD4+ = 160 cells/mm3; viral load HIV-1 = 144.000 copies/mL), and antiretroviral therapy was initiated. Impaired consciousness, ophthalmoplegia, limb weakness, ataxia, areflexia, and Babinsky´s sign were noted. At that moment, CD4+ count was 372 cells/mm 3 and viral load HIV-1 <50 copies/mL. The clinical, laboratory and neurophysiological findings suggest overlapping Guillain-Barre syndrome (GBS) and Bickerstaff brainstem encephalitis as manifestation of HIV-related immune reconstitution inflammatory syndrome (IRIS). Here, we review and discuss 7 cases (including the present report) of GBS spectrum as manifestation of HIV-related IRIS.

Keywords: Guillain-Barré syndrome; HIV-1; Immune reconstitution inflammatory syndrome; Peripheral neuropathy.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • CD4 Lymphocyte Count
  • Encephalitis* / diagnosis
  • Guillain-Barre Syndrome* / diagnosis
  • Guillain-Barre Syndrome* / etiology
  • HIV Infections* / complications
  • HIV Infections* / drug therapy
  • Humans
  • Immune Reconstitution Inflammatory Syndrome* / etiology
  • Male