Normonatremic osmotic demyelination in the setting of acquired immune deficiency syndrome and malnutrition: case report and literature review

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 mechan...

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Bibliographic Details
Published inJournal of neurovirology Vol. 22; no. 6; pp. 876 - 879
Main Authors Siegler, James E., Wang, Amber R., Vanderwerf, Joshua D.
Format Journal Article
LanguageEnglish
Published Cham Springer International Publishing 01.12.2016
Subjects
Acquired Immunodeficiency Syndrome - complications
Acquired Immunodeficiency Syndrome - diagnosis
Acquired Immunodeficiency Syndrome - immunology
Acquired Immunodeficiency Syndrome - virology
Adult
Aspergillosis - complications
Aspergillosis - diagnosis
Aspergillosis - immunology
Aspergillosis - virology
Aspergillus
Biomedical and Life Sciences
Biomedicine
Case Report
CD4 Lymphocyte Count
Demyelinating Diseases - complications
Demyelinating Diseases - diagnosis
Demyelinating Diseases - immunology
Demyelinating Diseases - virology
Fatal Outcome
Female
Humans
Immunology
Infectious Diseases
Malnutrition - complications
Malnutrition - diagnosis
Malnutrition - immunology
Malnutrition - virology
Neurology
Neurosciences
Osmotic Pressure
Viral Load
Virology
Osmotic demyelination
Acquired immune deficiency syndrome
Status epilepticus
Posterior reversible encephalopathy
Aspergillosis
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Summary: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.
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ISSN:1355-0284
1538-2443
DOI:10.1007/s13365-016-0463-2