Transvers Myelitis Due to HSV-2 Infection in an Undiagnosed HIV Positive Patient

Eda Çoban; Helin Serindağ; Zeynep Baştuğ Gül; Mesude Özerden; Aysun Soysal

doi:10.4274/tnd.2021.87259

Eda Çoban¹, Helin Serindağ², Zeynep Baştuğ Gül², Mesude Özerden², Aysun Soysal²

¹University of Health Sciences Turkey, Bagcilar Training and Research Hospital, Clinic of Neurology, Istanbul, Turkey
²University of Health Sciences Turkey, Prof. Dr. Mazhar Osman Mental and Neurological Diseases Training and Research Hospital, Clinic of Istanbul Neurology, Istanbul, Turkey

Keywords: Herpes simplex 2, HIV, myelitis

Abstract

Several disorders including inflammatory, ischemic, and metabolic can cause longitudinally extensive transverse myelopathy. HIV-associated spinal cord involvement is rare. It can be due to AIDS-associated myelopathy, or opportunistic infections such as cytomegalovirus and herpes simplex virus (HSV). Herein, we describe a 49-year-old man who presented with acute paraparesis and urinary retention. His spinal magnetic resonance imaging revealed extensive hyperintense signal in the long TR sequence throughout C2 to T12, especially in the posterior and lateral columns. Both HIV ELISA test and HSV-2 DNA polymerase chain reaction were positive. Despite treatment, his clinical condition deteriorated. Acute transverse myelopathy can be the initial manifestation of an asymptomatic undiagnosed HIV positive patient. Viral serology reveals the opportunistic infections underlying the disease thereby guiding therapeutic regimens.