Title : Hiv associated vasculopathy presenting as cerebrovascular accident in a young girl with HIV
Abstract:
Introduction: Stroke in a case of HIV, occurs by various mechanisms. The mechanisms include vasculi s secondary to opportunis c infec ons, HIV associated vasculopathy, cardioembolic stroke and HIV associated coagulopathy. Of these, the HIV associated vasculopathy is a diagnosis of exclusion. Here we present a case of HIV associated vasculopathy in a young girl with HIV.
Case presentation: The pa ent is a 14-year-old HIV infected girl, diagnosed at the age of 1 and has been drug default for the past 3 years. 1 month back, she was diagnosed with Ileocecal Tuberculosis and was started on An tubercular Therapy (ATT). 1 week later, pa ent developed ATT-induced hepa s and modified ATT regimen was started. The next week, pa ent presented to us with acute onset weakness of right upper and lower limbs. Pa ent was clinically diagnosed with cerebrovascular accident. MRI head showed an acute infarct in the le corona radiata and fusiform ectasia of Le terminal Internal caro d artery, le middle cerebral artery and le anterior communica ng artery. Cerebrospinal fluid analysis revealed a lymphocy c pleocytosis (cells = 70, lymphocytes – 70%) and elevated protein (70 mg/dl). Workup for tuberculosis, varicella zoster, toxoplasmosis and neurosyphilis turned out nega ve. Echocardiogram of the pa ent was also normal. Since the secondary causes were considerably ruled out, pa ent was diagnosed with HIV vasculopathy. The role of an platelets in HIV vasculopathy remains controversial. The pa ent was started on An-retroviral therapy. Her general condi on improved, but she had residual weakness of her limbs.
Discussion: The incidence of stroke in HIV varies from 1-5%. Stroke in HIV pa ents were seen in younger individuals compared to those in normal popula on. Ischemic stroke appears to be the predominant type comprising around 90% of individuals. HIV vasculopathy is a rare cause of stroke in HIV pa ents. The diagnosis requires significant vessel wall changes a er ruling out opportunis c infec ons. Effec ve ART plays a significant role in the preven on of HIV vasculopathy.
