Resumen
Introducción: la mielitis transversa longitudinalmente extensa (MTLE) se define como la inflamación de tres o más segmentos vertebrales. No es una entidad frecuente, y es incluso más extraña como manifestación inicial de la infección aguda por VIH.
Presentación del caso: un hombre de 28 años previamente sano se presenta con una cuadriparesia progresiva asociada a espasticidad e hiperreflexia. La RMN espinal demostró una hiperintensidad de los niveles T3 hasta T12, compatible con mielitis transversa longitudinalmente extensa; la serología para VIH fue reactiva, así como la reacción en cadena de la polimerasa (PCR) del virus de Epstein-Barr en líquido cefalorraquídeo (LCR). Dado que los estudios de extensión realizados descartaron infecciones oportunistas y otras causas de mielitis transversa longitudinalmente extensa, las manifestaciones clínicas se atribuyeron a la seroconversión aguda del VIH.
Discusión: la mielitis transversa aguda en pacientes con VIH es una condición poco frecuente que sólo se ha descrito en algunos reportes de caso durante la seroconversión. Adicionalmente, el hallazgo del virus de Epstein-Barr en líquido cefalorraquídeo tiene una significancia clínica incierta en los pacientes con VIH.
Conclusión: el caso resalta la importancia de considerar al VIH como posible causa en pacientes que se presentan con síntomas neurológicos, incluso si estos no son los clásicamente descritos para el VIH/SIDA. Adicionalmente, los estudios futuros deberían tener como objetivo la determinación de la verdadera importancia de la positividad de la reacción en cadena de la polimerasa de Epstein-Barr en líquido cefalorraquídeo para mejorar las estrategias terapéuticas y los posibles desenlaces.
Citas
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