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Intracranial hypertension and papilloedema as a complication to low antiretroviral therapy adherence in a man living with chronic HIV
  1. Rosa Maja Møhring Gynthersen1,
  2. Helene Mens1,
  3. Marianne Wegener2 and
  4. Neval Ete Wareham1
  1. 1Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
  2. 2Department of Ophthalmology, Rigshospitalet Glostrup, Glostrup, Denmark
  1. Correspondence to Dr Rosa Maja Møhring Gynthersen; rosa.maja.moehring.gynthersen.01{at}regionh.dk

Abstract

We describe a 61-year-old man living with HIV on antiretroviral therapy (ART), who presented with headache, dizziness and blurred vision. Latest CD4+ cell count 3 months prior to admission was 570×106 cells/mL and HIV viral load <20 copies/mL. The patient was diagnosed with cerebrospinal fluid (CSF) lymphocytic pleocytosis, raised intracranial pressure and papilloedema. Neuroimaging showed normal ventricular volume and no mass lesions, suggesting (1) neuroinfection (2) idiopathic intracranial hypertension or (3) retroviral rebound syndrome (RRS) as possible causes. Neuroinfection was ruled out and idiopathic intracranial hypertension seemed unlikely. Elevated plasma HIV RNA level was detected consistent with reduced ART adherence prior to admission. RRS is a virological rebound after ART interruption, which can mimic the acute retroviral syndrome of acute primary infection. To the best of our knowledge, we describe the second case of RRS presenting as CSF lymphocytic pleocytosis and elevated intracranial pressure after low ART adherence.

  • infectious diseases
  • HIV / AIDS
  • ophthalmology

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Footnotes

  • Contributors RMMG and NEW wrote this case report under the guidance of HM. MW contributed with the ophthalmological findings and provided funduscopy images. HM and MW contributed with writing assistance.

  • 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 None declared.

  • Patient consent for publication Obtained.

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

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