Adult Acute Disseminated Encephalomyelitis Associated with a Falsely Positive HIV Elisa Test

Abstract

Case Report: Acute disseminated encephalomyelitis (ADEM) is an acute disorder of the central nervous system that follows an infection or vaccination. It is a non-vasculitic inflammatory condition resulting in perivascular edema, inflammation, and demyelination that bears resemblance to multiple sclerosis. A 39-year-old African-American male presented with leg weakness, worsening thrush, altered mental status, and fever approx-iametely three weeks after an upper respiratory infection. On presentation, the patient was found to have a positive HIV ELISA test, fevers up to 103 degrees, worsening of his thrush, profound weakness, and diarrhea with fecal incontinence. On physical examination, a right facial droop was present, there was diffuse thrush on the tongue and painful cervical lymphadenopathy was present. There was spasticity present in the extremities, bilateral ankle clonus and decreased pinprick sensation in the right upper extremity. CSF studies showed 68 WBC, 96 RBC with 60% Lymphocytes, consistent with viral encephalitis. Patient had another HIV ELISA performed and a Western blot that were negative. The patient had a worsening paralysis and spasticity in the upper extremities. At that time, with a majority of the patient's CSF studies negative, the patient was diagnosed with ADEM. The patient was started on a course of plasmapheresis every other day and IVIG for 5 days. The onset of ADEM usually occurs in the wake of a clearly identifiable febrile prodromal illness or immunization and in association with prominent constitutional signs and encephalopathy. After identification of ADEM by MRI and exclusion of other possible causes of disease, it is crucial to rapidly institute a trial of high-dose corticosteroids to alleviate neurologic symptoms. Because of this patient's severe altered mental status and fever on initial presentation, as well as the falsely positive HIV ELISA, our case illustrates a rare presentation of an adult with ADEM. Causes of falsely positive HIV ELISA include vaccination or cross reaction of antibodies, which would be in increased circulation in a patient with ADEM.