Objective: The aim of this report is to highlight ataxia as an atypical symptom revealing HIV encephalitis associated with positive anti-neutrophil cytoplasmic antibodies (ANCA).

Background: Human Immunodeficiency Virus (HIV) encephalitis, a rare yet severe complication of HIV infection, is characterized by neuroinflammation predominantly targeting the central nervous system (CNS). While cognitive decline, behavioral alterations, and motor impairments are well-established manifestations, ataxia as an initial presenting symptom remains underrecognized. Notably, the presence of reported associated autoantibodies suggests a potential interplay between viral neuropathology and immune dysregulation.

Method: Case report.

Results: A 34-year-old woman with no significant medical history presented to the Neurology Emergency Department with acute-onset balance disturbances, memory impairment, behavioral abnormalities, and fever. The patient reported a 21-day history of hearing loss and ear pain prior to symptom onset, treated with antibiotics.

Neurological examination revealed temporal-spatial disorientation, frontal syndrome, static cerebellar syndrome, and vestibular dysfunction.

Brain MRI showed diffuse T2 and FLAIR hyperintensities affecting supratentorial brain suggestive of progressive multifocal leukoencephalopathy.

Laboratory findings demonstrated severe lymphopenia (330 cells/mm³) and a markedly elevated erythrocyte sedimentation rate of 138 mm/h. Cerebrospinal fluid (CSF) analysis revealed a normal white blood cell count (1 cell/mm³), and a normal CSF protein level (0.43 g/L). HIV infection was confirmed through Western blot antibody testing. Immunological workup showed positivity for ANCA. Further etiological investigations returned normal results.

A diagnosis of HIV encephalitis was eventually established, and the patient was transferred to the Infectious Diseases Department.

Conclusion: This case underscores ataxia as a rare but critical presenting feature of HIV encephalitis, expanding the clinical spectrum of HIV-associated movement disorders. Eventually, neuroimaging and serological testing are necessary in the diagnosis approach of ataxia. Further research is required to elucidate the mechanisms by which ANCA may influence HIV infection.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/ataxia-as-diagnostic-dilemmas-in-hiv-related-encephalitis-with-positive-autoantibodies/