ACUTE NEUROPATHY COINCIDENT WITH SEROCONVERSION FOR ANTI-LAV/HTLV-III

The authors report 2 cases from France in which seroconversion for lymphadenopathy-associated virus/human T-lymphotropic virus type III (LAV/HTLV-III) was associated with acute neuropathy. The 1st patient a 53-year old homosexual man presented with transient fever diarrhea truncal rash and intense pain in his calves. He subsequently developed facial diplegia sensory and motor impairment of the legs and arms and a short period of confusion with hallucinations. There was no serologic evidence of recent infection by cytomegalovirus measles hepatitis B virus toxoplasmosis or Epstein-Barr virus but tests for anti-LAV were positive in both serum and cerebrospinal fluid. T4 lymphocytes and T4:T8 ratio were both decreased while the number of T8 cells was increased. Symptoms receded over a 3 month period. The 2nd patients a 32-year old woman with no history of drug abuse presented with fever cervical lymphadenopathy and a truncal maculopapular rash. She later developed multiple enlarged lymph nodes splenomegaly and left facial palsy. The T4:T8 ratio was low due to an increase in T8 lymphocytes. Serologic tests for LAV were negative at the time of admission but positive 2 months later at the height of the patients symptoms. With the exception of thrombocytopenia the symptoms receded. The 1st patient had a single sexual partner who was symptomless but positive for LAV for the past 20 years. The 2nd patient had intercourse over the past 2 years with a bisexual who was positive for LAV. These cases demonstrate that neurotropism may be symptomatic early in LAV infection; thus primary LAV infection should be included among the causes of acute polyneuropathy.