Opsoclonus-myoclonus in an HIV-infected child on antiretroviral therapy--possible immune reconstitution inflammatory syndrome.
The exact immunopathogenesis and neuroanatomical localization of opsoclonus-myoclonus ataxia syndrome remains unclear. We describe a 1 year 9 month old girl who, shortly after commencement of highly active antiretroviral therapy developed opsoclonus-myoclonus syndrome and subsequently died of disseminated cytomegalovirus infection. We postulate on the etiological factors that may have played a role in the disease pathogenesis of the patient's opsoclonus-myoclonus ataxia. Immune reconstitution inflammatory syndrome was considered the most likely because of the initial CD4 depletion and the onset of symptoms shortly after initiation of antiretroviral therapy. Single photon emission computed tomography (SPECT) proved helpful by localizing the area of dysfunction to the cerebellar vermis.
van Toorn
Ronald
R
Department of Pediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University and Tygerberg Children's Hospital, P.O. Box 19063, Tygerberg 7505, Clinical Building 2nd Floor, Tygerberg, Western Cape, South Africa. vtoorn@sun.ac.za
Rabie
Helena
H
Warwick
James M
JM
D000324:Adrenocorticotropic Hormone / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D018791:CD4 Lymphocyte Count; D004569:Electroencephalography; D017809:Fatal Outcome; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D015497:HIV-1; D006801:Humans; D007223:Infant; D007249:Inflammation / Q000209:etiology / Q000473:pathology*; D020361:Paraneoplastic Syndromes, Nervous System / Q000139:chemically induced*; D020133:Reverse Transcriptase Polymerase Chain Reaction; D014057:Tomography, X-Ray Computed
D000893:Anti-Inflammatory Agents; D000324:Adrenocorticotropic Hormone