Menu
Disease
A-Z
Health Topics
Anogenital Disorders
Behavioral Disorders
Diet & Diseases
Gastrointestinal Disorders
General Pediatrics
Genetic Disorders
Homemade Remedies
Immunization & vaccines
Immunodeficiencies
Infectious Diseases
View all Topics
Featured Articles
Growth hormone deficiency
Skin allergies
Allergy
Absent testis in scrotum
Food allergies
Anaphylaxis
Kids Corner
Health and Knowledge with fun.
Drugs &
Calculators
Medical Calculators
Drug Calculators
Growth Calculators
Renal Calculators
View all Calcualtors
Drug Index
ACE inhibitor
Alkylating agents
Allergies
View all Drugs
Poisoning Center
Aluminum phosphide
Anti-histaminics
Antidepressants
View all Drugs
Medical Eqipments
Monitors
Pumps
Incubators
View all Equipments
Diagnostic Aid
Get your diffrential
diagnosis.
Consult
& Posts
Ask a Doctor
Diagnostic Dilemma
Question of the Day
Pediatric Blogs
Spot Diagnosis
Grand Rounds
Pedi Poll
Pediatric
Journal
Current Issue
Archives
About the Journal
Submit Article
Books
& Apps
Book Store
Pediatric Oncall
Medical Calculators
Vaccine Reminder
Pediatric Oncall Journal
Drug Center
Parenting
CME &
Videos
Upcoming Conferences
Conference Abstracts
MCQs
Videos
Vaccine
Reminder
Sign In
Grand Rounds
Home
|
All Grand Rounds
Continued Neurological Damage in HIV Infected Despite Antiretroviral Therapy
Ira Shah, Drishti Tolani
Pediatric HIV Clinic, Department of Pediatrics, B.J.Wadia Hospital for Children, Mumbai, India
Address for Correspondence: Dr Ira Shah, 1/B Saguna, 271/B St Francis Road, Vile Parle (W), Mumbai 400056, India.
Clinical Problem:
A 13 years old HIV infected boy on ART since 6 years of age presented with progressive increase of involuntary movements of left side of body with increased tone in Sept 2011. He was diagnosed to have left sided dystonia due to infarct in right lentiform nucleus & left cerebellar cortex in April 2004 due to positive antiphospholipid syndrome. (1) At that time he was diagnosed to be HIV infected and was started on Zidovudine (AZT), Lamivudine (3TC) and Nevirapine (NVP) along with aspirin and carbamazepine. His dystonia improved and in 2007 due to epistaxis, his aspirin was omitted. He continued to do well on ART till Feb 2010 when he had CMV retinitis. (2) At that time HIV viral load was undetectable and CD¬4 count was 920 cells/cumm. He was treated with valganciclovir to which his vision improved. His MRI brain in Feb 2010 showed thinning and atrophy of left cerebellar peduncle and left cerebellar hemisphere of unknown etiology. He continued to remain well till July 2011 when parents noticed increased falls due to increase in involuntary movements of left side of body. In Sept 2011, cerebrospinal fluid (CSF) was tested for cytomegalovirus (CMV), Herpes simplex virus (HSV), Epstein barr virus (EBV), HIV proviral DNA and Toxoplasma PCR which were all negative. A repeat MRI was done in Nov 2011 which showed hyper intensities in bilateral cerebellar hemispheres more marked on left side of unknown etiology and right putaminal area of gliosis suggestive of old insult. (Fig 1) His MR angiogram was normal. Subsequently, he became bedridden in Dec 2011 and was hospitalized. His CSF Measles and mumps antibodies were negative. His antiphospholipid antibody (APLA) and anti cardiolipin antibodies were also negative. A brain biopsy from right frontal lobe did not show any viral inclusion bodies. EEG showed generalized slowing. He was continued on ART but he succumbed to his illness.
Why did the child have continued neurological damage inspite of ART?
Previous Grand Rounds
View All
G
Granulomas in Chronic Granulomatous Disease
Ira Shah, Anmol Goyal
A 3 years old boy suffering from chronic granulomatous disease (CGD) presented with fever and cough. He was detected to have CGD at the age of 1 year 4 months in view of persistent pneumonia and a pos....
A
Acute Liver Failure due to acetaminophen toxicity - How to treat?
Ira Shah, Parth Gada
A 21 months old boy presented with fever, cough, cold for 4 days, drowsiness for 2 days and one episode of convulsion. He had been treated with oral paracetamol for the initial 2 days of fever every 4....
R
Refractory Iron Deficiency Anemia
Minhajuddin Ahmed Shweta Goyal Shweta Anand
A 10-year-old male child came to our out-patient department (OPD) for evaluation of refractory anemia. He had received adequate dietary and oral iron supplementation but still required multiple blood ....
D
Dermal swellings, joint contractures but no gingival hypertrophy
Ira Shah
An 18 month old girl born of third degree consanguineous marriage presented with gradual restriction of movements in both the limbs for 6 months. Patient had flexion contractures of both ankles, knee....
N
Neonatal cholestasis in an infant with Rh incompatibility
Ira Shah
A 1 ½ months old boy was referred for jaundice with clay stools since birth. There was history of Rh incompatibility which led to jaundice in neonatal period that required phototherapy and exchange tr....
Ask a Doctor
New Book Arrival
Infection in Children -
Part 2
Order Now
Recommended for you
Encopresis (Stool Soiling)
Periodontal Diseases
Eye Care
Calculators
Creatinine Clearance (Schwartz Formula)
Normal Values of GFR
Sodium Deficit in Hyponatremia
Biological values of various food items
Glucose Infusion Rate (GIR) Calculator
Grand Round
Dilemma
Continued Neurological Damage in HIV Infected Despite Antiretroviral Therapy
Answer
Cataracts
Hyperlipidemia in an hiv infected child on anti-retroviral therapy
Heart disease
A one year old boy presented with cough and fever for 7 days. There was no TB contact. On examinatio...
Answer
Antiretroviral therapy- underdosing
Ring enhancing granulomas on mri brain and measles
Tb culture
Pediatric Oncall Journal
LETTER TO EDITOR (VIEWERS CHOICE)
Obstructive Sleep Apnea in a Patient of Achondroplasia
IMAGES IN CLINICAL PRACTICE
Abdominal Distension (Prune Belly Syndrome)
GRAND ROUNDS
Refractory Iron Deficiency Anemia
MCQ
MCQs Set 1
Quiz on Kawasaki Disease
MCQs Set 3
MCQS ON PEDIATRIC EMERGENCIES
MCQs in Neonatal Resuscitation
Disclaimer: The information given by www.pediatriconcall.com is provided by medical and paramedical & Health providers voluntarily for display & is meant only for informational purpose. The site does not guarantee the accuracy or authenticity of the information. Use of any information is solely at the user's own risk. The appearance of advertisement or product information in the various section in the website does not constitute an endorsement or approval by Pediatric Oncall of the quality or value of the said product or of claims made by its manufacturer.
X
Sign In
Disease A-Z
Health Topics
Anogenital Disorders
Behavioral Disorders
Diet & Diseases
Gastrointestinal Disorders
General Pediatrics
Genetic Disorders
Homemade Remedies
Immunization & vaccines
Immunodeficiencies
Infectious Diseases
View all topics
Featured Articles
Growth hormone deficiency
Skin allergies
Allergy
Absent testis in scrotum
Food allergies
Anaphylaxis
Kids Corner
Drugs & Calculators
Medical Calculators
Drug Calculators
Growth Calculators
Renal Calculators
View all Calculators
Drug Index
ACE inhibitor
Alkylating agents
Allergies
View all Drugs
Poisoning Center
Aluminum phosphide
Anti-histaminics
Antidepressants
View all Drugs
Medical Eqipments
Monitors
Pumps
Incubators
View all Eqipments
Diagnostic Aid
Consult & Posts
Ask a Doctor
Diagnostic Dilemma
Question of the Day
Pediatric Blogs
Spot Diagnosis
Grand Rounds
Pedi Poll
Pediatric Oncall Journal
Current Issue
Archives
About the Journal
Submit Article
Books & Apps
Book Store
Pediatric Oncall
Medical Calculators
Vaccine Reminder
Pediatric Oncall Journal
Drug Center
Parenting
CME & Videos
Upcoming Conferences
Conference Abstracts
MCQs
Videos
Vaccine Reminder