title: Normonatremic osmotic demyelination in the setting of acquired immune deficiency syndrome and malnutrition: case report and literature review.
abstract: In this report, we present the case of a 43-year-old woman with AIDS, disseminated aspergillosis, and malnutrition who developed osmotic demyelination syndrome. AIDS-related osmotic demyelination has only been documented in a handful of cases to date, and it appears independent of the classic mechanism of rapid correction of hyponatremia. In this manuscript, we review the six prior cases of osmotic demyelination in AIDS patients and compare their circumstances to that of our own patient. It appears that complications of malnutrition, possibly related to depletion of organic osmolytes in the central nervous system, may place AIDS patients at greater risk of osmotic demyelination. These, and other proposed mechanisms, deserve further inquiry.
authors.affiliation: Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce St., 3W Gates, Philadelphia, PA, 19104, USA. james.siegler@uphs.upenn.edu.
authors.forename: James E
authors.initials: JE
authors.lastname: Siegler
authors.affiliation: Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, 19103, USA.
authors.forename: Amber R
authors.initials: AR
authors.lastname: Wang
authors.affiliation: Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce St., 3W Gates, Philadelphia, PA, 19104, USA.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Vanderwerf
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications / Q000175:diagnosis* / Q000276:immunology / Q000821:virology; D000328:Adult; D001228:Aspergillosis / Q000150:complications / Q000175:diagnosis* / Q000276:immunology / Q000821:virology; D018791:CD4 Lymphocyte Count; D003711:Demyelinating Diseases / Q000150:complications / Q000175:diagnosis* / Q000276:immunology / Q000821:virology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D044342:Malnutrition / Q000150:complications / Q000175:diagnosis* / Q000276:immunology / Q000821:virology; D009997:Osmotic Pressure; D019562:Viral Load
keywords: Acquired immune deficiency syndrome; Aspergillosis; Osmotic demyelination; Posterior reversible encephalopathy; Status epilepticus