AN UNSUSPECTING CASE OF ATYPICAL HIV ENCEPHALOPATHY

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Acute encephalopathy has a broad differential diagnosis. HIV infection can present as serious neurological manifestations varying from seizures, encephalopathy, severe headaches, photophobia or meningismus. These presentations are scarce within themselves but even more rare is acute in seronegative individual. Below case report based on an with seroconversion. CASE PRESENTATION: A 32 Morbid obese female past medical history of Type 2 Diabetes Mellitus and recent outpatient treatment for Strep throat. She presented to ED tonic-clonic seizures progressing status-epilepticus requiring mechanical ventilation. Labs admission were significant elevated blood sugar, lactic acidosis, positive beta-hydroxy butyrate, creatinine urine drug screen marijuana. CT head showed no intracranial pathology. Electroencephalogram (EEG) sedation was negative epileptiform discharges. MRI brain mild symmetrical T2 flair hyper density the caudate posterior hippocampal regions. Patient started Keppra. CSF analysis TB, cryptococcal, herpes syphilis. It wasn't indicative either bacterial viral etiology. Septic work up returned negative. On her antibody negative; however, p24 antigen positive. day 12 she seroconverted. Her load 3,930,000 CD4 count 664. Post extubation Biktarvy decreased 66,400. followed great compliance not had recorded seizure since then mental status back baseline. DISCUSSION: been noted affect CNS by inflammatory mediated neurotoxic changes, replication. Therefore, some experts believe that swift initiation HART prevent further replication reduce time period process. Our one where organisms grew septic radiographic imaging only signal intensity changes areas usually associated typical encephalopathy. Initiating such patients important limiting event, however this should educate other clinicians atypical presentation specially who seronegative. CONCLUSIONS: Typically, have very non-specific thus difficult diagnose. suggestive cerebral atrophy diffuse white matter. clinician needs high grade suspicion include differential. REFERENCE #1: P. Shah, R. Paul, Gold, K. Tashima, T. Flanigan Treating Encephalopathy Antiretroviral Therapy: Clinical Demonstrating Success HAART. Infectious Diseases. 2008; 39,1545–47, https://doi.org/10.1086/425119 #2: V. M. Daliparty, Balasubramanya. Encephalitis. https://www.ncbi.nlm.nih.gov/books/NBK555894/ DISCLOSURES: No relevant relationships Obed Adarkwah, source=Web Response Aneeta Kumari, Steven Miller, Kunal Nangrani, Gaurav Parhar, disclosure file Dhruv Patel; jad sargi, Kiran Zaman, John Zeibeq,