Abstract:
OBJECTIVE:To define a clinical syndrome associated with active drug abuse in HIV-infected individuals. METHODS:We performed a retrospective review to identify individuals treated at the Johns Hopkins Hospital from 1993 to 2008 who were HIV-infected and were actively abusing drugs and had bilateral basal ganglia lesions on MRI. They were identified using a key word search in the radiology database, autopsy database, and the Moore HIV clinic database. Clinical, laboratory, and radiographic findings were correlated to define the syndrome. RESULTS:Ten individuals were identified who presented with a change in mental status or seizures, used cocaine or cocaine with heroin, had uncontrolled HIV infection (>190,000 copies/mL of plasma), elevated CSF protein (63-313 mg/dL), and diffuse hyperintense bilateral basal ganglia lesions on imaging. The majority of patients (8/10) had renal failure and despite supportive therapy most (7/9) ultimately died (median survival 21 days). Postmortem examination in one individual showed the presence of overwhelming microglial activation in the basal ganglia. The 2 surviving individuals were started on combined antiretroviral therapy (CART) during hospitalization. CONCLUSION:We describe a unique clinical syndrome of a fulminant encephalopathy associated with primarily basal ganglia involvement in HIV-infected drug abusers. This syndrome is a rare but serious condition that is associated with a high mortality rate. Early CART institution may be useful and neuroprotective in this disorder, although this requires further investigation.
journal_name
Neurologyjournal_title
Neurologyauthors
Newsome SD,Johnson E,Pardo C,McArthur JC,Nath Adoi
10.1212/WNL.0b013e31820e7b4esubject
Has Abstractpub_date
2011-03-01 00:00:00pages
787-94issue
9eissn
0028-3878issn
1526-632Xpii
76/9/787journal_volume
76pub_type
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