Table 1 Table showing the typical case of HIV-VM vs. our case

Onset and presentation

Signs and symptoms develop over the subacute–chronic period

Signs and symptoms developed acutely

Atypical

Clinical manifestations

 Motor exam

 Tone

Spastic

Flaccid

Atypical

 Power/weakness pattern

Paraparesis, unless the cervical cord is involved, in which case the patient would have quadriparesis

Quadriparesis due to the presence of cervical and thoracic cord atrophy

 Reflexes

Increased

Global areflexia

Atypical

 Sensory exam

Usually, no sensory level

Difficult to ascertain due to her confused state, but she did respond to pain and light touch

 GAIT

Ataxic gait

Inability to walk

Atypical

 Comorbid status/conditions

In the setting of advanced HIV, however also in cases with normal immune status

Pt was virologically suppressed

HIV-VL(< 20 copies/ml), CD5 – 1051 cells/ul

Atypical

HIV-NCD

Confused but could also be explained by electrolyte imbalance and secondary sepsis. Not simply by HIV-NCD

 Radiological findings

MRI scans are useful in diagnosis; T2-weighted images often show symmetric non-enhancing high signal areas present on multiple contiguous slices, which result from extensive vacuolation (hence the name). Lesions may be confined to the posterior column, especially the gracile tracts, or be diffuse [3, 7]

The MRI spine, however, showed diffuse cord atrophy with dorsal signal abnormality involving the lower cervical and thoracic spine, as shown in Figs. 1 and 2 (Appendix B)

 Treatment options

Symptomatic therapies: cART

IVIG

[3, 10]

Symptomatic therapies: correction of renal failure, electrolyte imbalance, and treatment of sepsis

cART

IVIG showed no improvement

Atypical