CLINICOPATHOLOGICAL CONFERENCE

Progressive neuropsychiatric problems following institution of highly active antiretroviral therapy

R F Miller¹, S S Dave¹, J W Tang², P J Shaw³, H R Jäger³ and E G L Wilkins⁴

¹ Patrick Manson Unit, University College London Hospitals, and Mortimer Market Centre, Camden PCT, London WC1E 6AU, UK
² Department of Virology, University College London Hospitals, London W1T 4JF, UK
³ Department of Imaging, University College London Hospitals, London WC1E 6DB, UK
⁴ Department of Infectious Diseases, North Manchester General Hospital, Manchester M8 5RB, UK

Correspondence to:
Correspondence to:
Dr R F Miller
Mortimer Market Centre, RFUCMS, University College London, London WC1E 6AU, UK; rmiller{at}gum.ucl.ac.uk

A 31 year old HIV infected woman developed neuropsychiatric problems soon after starting highly active antiretroviral therapy (HAART). Despite modifying and subsequently stopping HAART her condition progressively worsened. Cranial magnetic resonance imaging revealed multiple areas of abnormal signal suggestive of either a vasculitis or demyelination.

Abbreviations: AAFB, alcohol and acid fast bacilli; ADEM, acute disseminated encephalomyelitis; CMV, cytomegalovirus; CRP, C reactive protein; CSF, cerebrospinal fluid; CT, computed tomography; DSA, digital subtraction angiography; EBV, Epstein-Barr virus; FSE, fast spin echo; HAART, highly active antiretroviral therapy; HSV, herpes simplex virus; IRIS, immune reconstitution inflammatory syndrome; MAC, Mycobacterium avium complex; MRI, magnetic resonance imaging; NNRTI, non-nucleoside reverse transcriptase inhibitor; NRTI, nucleoside reverse transcriptase inhibitors; PML, progressive multifocal leucoencephalopathy; VZV, varicella zoster virus

Keywords: highly active antiretroviral therapy; neuropsychiatric problems

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