Jpn. J. Infect. Dis., 53, 2000

Laboratory and Epidemiology Communications

Successful Treatment of Acute Myeloradiculoneuritis with High‑Dose
Corticosteroids in a Patient with Primary HIV‑ 1 Infection
Chie Yasuoka, Yoshimi Kikuchi, Akira Yasuoka, Masazumi Yamaguchi,
Yoshihiko Yamamoto, Ikumi Genka, Katsuji Teruya,
Natsuo Tachikawa, Tomoyuki Shimpol and Shinichi Oka*AIDS Clinical Center and lDepartment of Neurology, International Medical Center ofJapan,
Toyama I‑21‑1, Shinjuku‑ku, Tokyo 162‑8655
Communicated by Hiroshi Yoshikura(Accepted August 1 5, 2000)

aminotransferase (AST) was 425 IU/1 (normal < 35), alanine
amlnOtranSferase (ALT) was 380 IU/1 (normal < 30), andalkaline phosphotase (ALP) wTs 1 13 1 IU/I (normal < 340)･

VariOus neurological complications concomitant with HIVl
1 seroconversion usually occur within 1 mon仇of a mono‑

nucleosis‑like illness. They Include peripheral neuropathy,radiculopathy, facial palsy, Guillain‑Barr6 syndrome, brachial

IgM antibodies to cytomegalovlmS (CMV) and Epstein‑Ba灯

virus, and IgGantibodies to hepatitis C virus were all negative.

peuritis, meningoencephalitis ( 1 ), ataxic neuropathy (2), andlntracranial hypertension (3). However, myelopathy rarely

Hepatitis B surface antibody had previously been positive.

appears,and only one case was reported in 1986 (4). We report
here the first case of acute myeloradiculoneuritis (AMRN)

An ultrasoni.c echogram (UEG) showed mild hepatomegaly,

treated successfully with high‑dose corticosteroids in adiameter) in a caudate lobe of the liver. The ELISA screenlng

intra‑abdomlnal lymphadenopathy, and a small cyst (1 cワintest for HIV‑1 was positive. Westem blot analysts revealed

patient with primary HIV‑ 1 infection.
A 36‑year‑old man presented with a 2‑week history ofp55 and p24 bands. On April 26 he devdoped an unsteady
gait and fell over while walking. He was referred to ourhospital on April 28 (Figure) for treatment. Dysesthesia andfever, fatigue, Sore throat,and lymphadenopathy in early Aprilof 1999. He visited a hospital on April 16. Asparate

ad miss ion▼4勺)333 0 9 8 7 QE)(3.)巴n一eJOduJe1

musctepower(M T)

LO 4 3 2

Ap州2830May24681012141618202224262830

戸舶bbodCD4VpI)

107571

7.5× 103

HIV RNA(/ml) 1,3 × 108

8 ×9 13013212SE
123216ceJJ count(/pl)
protein(mg/dl)

Figure. Clinical course of acute myeloradiculoneuritis in a patient with primary HIV‑I infection.

HAART: highly active antiretroviral therapy; ZDV: zidovudine; 3TC: lamivudine; SQV: Saquinavir; RTV:ritonavir;
CSF: cerebrosplnalnuid*Corresponding author: Tel/Fax: +8 1 ‑3‑5273‑5 1 93, E‑mail: oka@
imcj.hosp.goJP171Jpn. J. Infect. Dis., 53, 2000

paralysIS under both knees were noted. Dysesthesia

UEG showed multiple cystsinthe hver. Entamoeba histolytica

progressed to the nlPPle level, and anesthesia developed in

was detected in the aspirate ofa cyst. He was then treatedthe legs. Vesicorectal disorder soon appeared, and he waswith metronidazole for 3 weeks. In June, HIV RNA wassubsequently unable to wan( evenwith support. A neurologicalsuppressed to under 400/ml, but in Westem blot all the HIV

examination on May 6 revealed loss of tactile and palm Sensa‑bands were detectable. The Entamoeba histolytica hvertions below the Th3 level and a moderate loss ofpositional

abscess was successfully treated. The patient was able toand vibratory sensations in the right leg. Mild dysesthesia

resume his former way of life 6 Weeks after admission to ouralso appeared in his forearms and hands. Flaccid paraplegla,hospital.

areflexia and severe weakness (grade 2/5) of the muscles in

The patient received HAART at the time of seroconversion.

the lower legs also appeared. Babinski sign was positive on

Early intervention was intended to reduce dissemination ofHIV not only to the lymphoid organs but also to the central

both sides.

On admission, his leukocyte count was 14,300/lil (70%1ymphocyte, 3% atypical lymphocyte). The CD4 count wasprogressed. We treated the patient with high‑dose intravenous571/〝1. The CD8 countwas as high as 8,068/〝L AST was

methylprednisolone to mltlgate excessive innammation. The

229 IU/1, AiT was 341 IU/1, andALP was 898 TU/I. In Westemtherapy was so effective that the neurologlCa) disorderimproved in 3 days. Use or corticosteroids increases the risk

neⅣous system. However, in this case, neurological symptoms

blot (LAV blot, FUJIREBIO INC., Tokyo) pl8, p24, p55 and
gp160 bands were detected. The plasma contained 1.3 × 10̀

of manifestation of an endogenous opportunistic infection.

HIV 1 RNA copies/ml. CMV antigen was absent in仇e blood.

Ac山ally, hepatic amebiasis occu汀ed in this case. Therefわre,On May 6, the cerebrospinal fluid (CSF) was clear; the total
cell count (100% lymphocyte) was 23/LEI, total protein wasI 16 mg/dl (IgG index 1.4; nomal level < 0.7), and glucose
was 45 mg/dl (nomal range: 40 ‑ 70). HIV‑1 RNA in CSF
was 36,000 copies/ml. Herpes simplex vims and varicella‑

it is important to pay close attention to the potential develop‑

ment of opportunistic infectionswith a high‑dose cortico‑steroid treatment. Though the CD4 count decreased to 1 07/
lil after the high dose of the corticosteroid, it recovered to893/LEI in 2 weeks, and HIV level was successfully controlled
by HAART. Thus, this clinical study clearly demonstrates

zoster vims were negative in PCR assay. Brain CT and mag‑netic resonance imaglng Of the thoracic spinal cord identifledthat the use ofa high dose ofcorticoids is safe for patientsno abnormal lesions. Evoked electromyogram (obtained onwith a prlmary HIV infection.

May 7) showed a nomal amplitude of the M wave and aThis work was supported by the Ministry of Health andWelfare of Japan and by the Organization of Pharmaceuticaldiminished F wave fbllowlng Stimulation or the right tibial

nerve in the ankle. Motor conduction velocities in the rightperoneal and tibial nerves were delayed to 36 m/S (nomalSafety and Research (OPSR). The authors thank Helen Fraser

rFnge: 43 ‑ 62) and 39 m/S (normal range: 41 ‑ 62), respec‑

for her careful reading and editing of the manuscript.

tlVely･ That oftheright medianヮerve (54 m/S) was within theno‑al range. Therefわre, the leslOnS in the spinal cord, neⅣe

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