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Paraparesis in a patient with advanced HIV infection: a diagnostic conundrum
  1. Anupa John1,
  2. Nitin Gupta2,3 and
  3. Kavitha Saravu2,3
  1. 1General Medicine, Kasturba Medical College Manipal, Manipal, Karnataka, India
  2. 2Department of Infectious Diseases, Kasturba Medical College Manipal, Manipal, Karnataka, India
  3. 3Prasanna School of Public Health, Manipal Centre for Infectious Diseases, Manipal, Karnataka, India
  1. Correspondence to Dr Kavitha Saravu; kavithasaravu{at}


In patients with HIV infection, lower limb weakness is a result of the pathological involvement of the brain, spinal cord or peripheral nervous system. The pathological process can be opportunistic infections, nutrient deficiencies, neoplastic infiltration or HIV itself. Here, we present the case of a 50-year-old manual labourer who presented with gradually progressive lower limb weakness, sensory disturbances, impotence and urinary urgency. He was diagnosed with HIV during evaluation. Based on the presentation and other supportive laboratory and radiological evidence, the following differentials were considered: vacuolar myelopathy, amyotrophic lateral sclerosis and myeloradiculopathy. The patient was initiated on antiretroviral therapy, and he showed significant improvement of symptoms on follow-up. We report this case to discuss the diagnostic puzzle.

  • HIV / AIDS
  • tropical medicine (infectious disease)
  • motor neurone disease
  • infection (neurology)
  • spinal cord

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  • Contributors AJ and NG were involved in the conception of the work and drafting of the article. AJ, NG and KS were involved in the patient management. Critical revision and overall supervision of the report was done by KS.

  • 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.