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A 32-year-old man is evaluated for a 3-month history of progressive, symmetric proximal and distal weakness. He was diagnosed with HIV infection 2 weeks ago and is taking combination therapy with efavirenz, zidovudine, and lamivudine.
On examination, he has diffuse extremity weakness, areflexia, and decreased vibratory sensation in the distal upper and lower extremities.
What is the most likely diagnosis?
A Vasculitic neuropathy
B Chronic inflammatory demyelinating polyneuropathy
C Cytomegalovirus polyradiculopathy
D Toxic neuropathy
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its vacouloar myelpathy..seen charac in hiv pts..it is mostly due to cmv i guess...nt sure tho..
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SINCE PT HAS MUSCLE WEAKNESS..IT CANT BE VACOULAR..
VL GO WITH TOXIC..
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all the ans hav come out.... now u come out with ans epi...
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in HIV positive it's demyelinating polyneuropathy- so it's B
in AIDS it's a distal sensorimotor polyneuropathy with painful paresthesia
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k enough tries..correct answer is B
Key Points
* Chronic inflammatory demyelinating polyneuropathy, the chronic form of Guillain“Barré syndrome, is characterized by proximal and distal weakness, areflexia, and distal sensory loss.
* Chronic inflammatory demyelinating polyneuropathy progresses in a stepwise or relapsing course for at least 8 weeks and can occur early in the course of HIV infection.
Chronic inflammatory demyelinating polyneuropathy is the chronic form of Guillain“Barré syndrome in which symptoms progress for at least 8 weeks. The clinical features are similar to those of Guillain“Barré syndrome and include proximal and distal weakness, areflexia, and distal sensory loss. The two disorders can both occur early in the course of HIV infection, in which case cerebrospinal fluid pleocytosis may occur along with an elevated cerebrospinal fluid protein concentration.
Although vasculitic neuropathy may present subacutely, it is predominantly asymmetric and associated with severe pain. Cytomegalovirus polyradiculopathy occurs in patients with end-stage AIDS and generally presents with symptoms of leg weakness, œsaddle anesthesia, and urinary retention. Toxic neuropathies may also present acutely but are generally axonal and present with distal sensory loss and weakness with only loss of the Achilles tendon reflexes (rather than diffuse areflexia).
