Facial diplegia and vestibular neuritis secondary to HIV seroconversion syndrome.

CASE REPORT The patient is a 60-year-old heterosexual male with a past medical history of morbid obesity and chronic obstructive pulmonary disease. He had been in his usual state of health until approximately four weeks prior to admission, when he developed low grade fever, rhinorrhea, sore throat and diffuse arthromyalgias. Fever resolved promptly after treatment with amoxycillin and clavulanic acid. Later on he was admitted to our institution with a five-day history of constant dizziness, unsteadiness and imbalance. By the time of admission he additionally experienced perioral numbness followed suddenly by lack of facial movements, with failure of both eyes to close and difficulty in sucking, smiling and talking. Neurological examination revealed bilateral peripheral facial palsy, rightdeviation tendency in past pointing and Quix tests, and mild unsteadiness with gait deviation to the right. The remainder of physical and neurological examination was normal, including intact reflexes. Laboratory studies disclosed an erythrocyte sedimentation rate of 51 mm/h. White blood cell count was 12.4 x 109 cells/l, with 35.6% neutrophils, 48.6% lymphocytes and 12.3% monocytes. Red blood cell and platelet counts were within normal limits. Autoantibody screening tests and blood biochemistry parameters, including angiotensin converting enzyme, were also normal. Cerebrospinal fluid (CSF) contained 30 cells/μl with 93% lymphocytes, protein 1.64 g/l and glucose 2.6 mmol/l (serum glucose 6.7 mmol/l). Cytology was negative. No organism was seen on Gram-stained smear, and cultures of CSF for bacterial, mycobacterial, viral and fungal organisms were also negative. Polymerase chain reaction and serologies for citomegalovirus, varicella zoster virus, Epstein-Barr virus, type 1 and 2 herpes simplex virus, Toxoplasma gondii, Cryptococcus, Brucella, Treponema pallidum, and Borrelia burgdorferi were negative in both serum and CSF. Human Immunodeficiency Virus testing was positive by ELISA and was confirmed by Western blot. CD4+ cell count was 252 cells/μl and CD8+ cell count was 5027 cells/μl, with CD4/CD8 ratio at 0.05. Viral RNA load was 197 000 copies/ml. A gadolinium enhanced brain magnetic resonance imaging showed normal findings. Electrophysiological study confirmed severe impairment of