Chronic Demyelinating Polyradiculoneuropathy Associated with -Human Immunodeficiency Virus- Infection: Different Clinical Features and Diagnostic Problems

Abstract

During the course of human immunodeficiency virus (HIV) infection, which leads to a chronic infectious disease that suppresses the cellular immune system, various types of peripheral neuropathies can be seen in different stages from seroconversion to the advanced stage. Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) usually occurs in early or mid-stage of the disease. In this study, we are presenting a 66 year-old man who was admitted to our clinic due to progressive and predominantly sensorial symptoms and signs of CIDP, who had recently been operated for carpal tunnel syndrome which was suggested by electromyography even though he had complains of diffuse polyneuropathy symptoms from the beginning. During his diagnostic work-up cerebrospinal fluid (CSF) analysis had revealed elevated protein and pleocytosis, and further investigation revealed HIV-1 infection. Areas of demyelination are very common in usual entrapment zones in the course of CIDP, which is a neuropathy with multi-segment demyelination in peripheral nerves and/nerve roots. Without a detailed patient history and examination, and a detailed EMG evaluation, a diffuse neuropathy can be misdiagnosed as an entrapment neuropathy. As it is in our case, this can lead to an unnecessary surgery and a delay in the actual diagnosis. CSF examination is very valuable for the investigation of the etiology of chronic demyelinating polyneuropaties. In CIDP patients, only protein elevation can be seen in CSF analysis; however, in the presence of pleocytosis, other diseases such as chronic infections, particularly HIV infection, other chronic inflammatory diseases, and malignant infiltration of nerve roots should be investigated.