Affiliations: Department of Pediatrics, Medical College, Kolkata,
India | Apex HIV Clinic, Medical College, Kolkata, India
Note:  Correspondence: Dr. Chanchal Kumar Kundu, %Resident in
Pediatrics, Medical College, Roy Bahadur Road, Behala, Kolkata, 700034, India.
Tel.: +91 9674217604; Fax: +91 9674217604; E-mail: [email protected]
Abstract: We present a case report of a young child with fever for 2 weeks
followed by ataxia, spastic quadriparesis, aphasia with bulbar palsy, and
lastly loss of consciousness. All symptoms developed within a span of 5 days.
Provisional diagnosis of infantile stroke due to infective vasculitis was made.
Cranial computed tomography revealed multiple infarctions with bilateral
dilated ventricles and mild cortical atrophy. Based on cerebrospinal fluid
analysis, contact history and Mantoux test, anti-tubercular therapy was
started. Therapeutic failure led to a suspicion of immunosuppression. So,
opportunistic infections of central nervous system along with neurotuberculosis
were ruled out by relevant standard tests. Subsequently human immunodeficiency
virus encephalopathy was diagnosed and highly active antiretroviral therapy was
initiated immediately. Neurological abnormalities reversed and complete
radiological clearance was noted with highly active antiretroviral therapy
within 1 year. The unusual presentation, rare neuroimaging findings, and
dramatic response make this case notable.
Keywords: HIV encephalopathy, infantile stroke, cerebral infarctions, highly active anti-retroviral therapy