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CASE REPORT
Inflammatory flaccid myelitis in a patient with both anti-CRMP-5 IgG and CNS HIV escape
  1. Rajan P Arora1,
  2. Andrew K Treister1,
  3. Maile Y Karris2 and
  4. Ronald J Ellis1
  1. 1 Department of Neurosciences, University of California San Diego, San Diego, California, USA
  2. 2 Department of Medicine, University of California San Diego, San Diego, California, USA
  1. Correspondence to Dr Andrew K Treister, andrewtreistermd{at}gmail.com

Abstract

Anticollapsin-responsive mediator protein 5 (CRMP-5) IgG is an antibody generally associated with small-cell lung cancer, which is known to cause paraneoplastic neurological syndromes, including encephalitis, myelitis and neuropathy. HIV escape is a phenomenon in which a patient with low or undetectable levels of HIV RNA in plasma is found to have elevated levels in cerebrospinal fluid (CSF). We present a case of a 58-year-old HIV-positive woman with undetectable plasma viral load who developed a subacute flaccid paraparesis. Over the course of 4 months, she had a broad inflammatory and infectious workup that was unrevealing until repeat imaging showed an inflammatory myelitis. Workup was notable for elevated HIV RNA copies in CSF, as well as anti-CRMP-5 autoantibodies in serum. Despite changing her antiretroviral therapy and multiple modalities of immunomodulation, the patient failed to respond adequately to treatment. This case illustrates a complex clinical picture with a unique presentation of anti-CRMP-5 myelitis.

  • HIV/AIDS
  • spinal cord
  • immunology
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Footnotes

  • Contributors RPA and AKT drafted the original manuscript and performed the literature review. MYK and RJE provided substantial revisions.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests MYK reports grants from GS-US-311-1717 (Gilead Sciences) outside the submitted work. The other authors have nothing to disclose.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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