A great simulator in clinical practice: mononeuritis multiplex in HIV infection

TL;DR

This paper describes a case where an HIV-infected patient presented with mononeuritis multiplex, highlighting the complex and varied clinical manifestations of HIV.

Contribution

The case highlights polyarteritis nodosa-like vasculitis as a rare manifestation of HIV-related autoimmunity.

Findings

A 39-year-old woman with HIV presented with arthritis, weight loss, and multiple mononeuropathy.

Nerve biopsy revealed necrotizing vasculitis not linked to CMV co-infection.

The case suggests HIV-related autoimmunity can lead to vasculitis mimicking polyarteritis nodosa.

Abstract

HIV infection is a chameleon, mimicking several diseases. Herein, we report a previously healthy 39-year-old woman who, over 2 months, developed arthritis, weight loss, and confluent multiple mononeuropathy. Extensive laboratory investigation showed positive serology for HIV, with a CD4 count of 100 cells, and necrotizing vasculitis on a nerve biopsy not associated with CMV co-infection, allowing the diagnosis of polyarteritis nodosa-like vasculitis in an HIV-infected patient. Apart from the infection, HIV-related autoimmunity can affect any organ and contribute to the complexity of the clinical presentation of HIV infection.

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