Peripheral neuropathy associated with acquired immunodeficiency syndrome (AIDS)-related Burkitt's lymphoma.

Peripheral neuropathy associated with acquired immunodeficiency syndrome (AIDS)-related Burkitt's lymphoma usually occurs as a toxic effect of chemotherapeutic agents. Whereas primary peripheral nerve involvement is an unusual complication, we report on a human immunodeficiency virus (HIV)-positive patient with Burkitt's lymphoma and sciatic neuropathy due to compression by a lymphomatous mass. Therapy with radiation and chemotherapy was followed by clinical and radiological improvement, but recurrent neurological deficits in a similar distribution occurred later from lymphomatous meningitis.

HIV-associated peripheral neuropathy: epidemiology, pathophysiology and treatment.

Peripheral neuropathy is the most frequent neurological complication associated with human immunodeficiency virus type 1 (HIV) infection and advanced acquired immunodeficiency syndrome (AIDS). There are at least 6 patterns of HIV-associated peripheral neuropathy, although these diagnoses are often overlooked or misdiagnosed. Distal symmetrical polyneuropathy (DSP) is the most common form of peripheral neuropathy in HIV infection. DSP occurs mainly in patients with advanced immunosuppression and may also be secondary to the neurotoxicity of several antiretroviral agents. Treatment of painful DSP is primarily symptomatic, while pathogenesis-based therapies are under investigation. Reduction or discontinuation of neurotoxic agents should be considered if possible. Inflammatory demyelinating polyneuropathy (IDP) can present in an acute or chronic form. The acute form may occur at the time of primary HIV infection or seroconversion. Cerebrospinal fluid lymphocytic pleocytosis (10 to 50 cells/mm3) is helpful in the diagnosis of HIV-associated IDP. Treatment consists of immunomodulatory therapy. Progressive polyradiculopathy (PP) most commonly occurs in advanced immunosuppression and usually is caused by cytomegalovirus (CMV) infection. Rapidly progressive flaccid paraparesis, radiating pain and paresthesias, areflexia and sphincter dysfunction are the cardinal clinical features. Rapid diagnosis and treatment with anti-CMV therapy are necessary to prevent irreversible neurological deficits resulting from nerve root necrosis. Mononeuropathy multiplex (MM) that occurs in early HIV infection is characterised by self-limited sensory and motor deficits in the distribution of individual peripheral nerves. In advanced HIV infection, multiple nerves in two or more extremities or cranial nerves are affected. Treatment includes immunomodulation or anti-CMV therapy. Autonomic neuropathy may be caused by central or peripheral nervous system abnormalities. Treatment is supportive with correction of metabolic or toxic causes. Diffuse infiltrative lymphocytosis syndrome (DILS) presents as a Sjögren's-like disorder with CD8 T cell infiltration of multiple organs. Antiretroviral therapy and steroids may be effective treatments.

Neuromuscular complications of the human immunodeficiency virus type 1 infection.

Neuromuscular disorders are the most frequent neurologic complications associated with human immunodeficiency virus (HIV) infection and AIDS. Although neurologic disorders are frequently overlooked, they add considerable morbidity and mortality to patients with HIV infection. It is critically important to properly diagnose and treat these neuromuscular complications, which leads to substantial improvement in patients' quality of life. Distal symmetric polyneuropathy is the most common form of peripheral neuropathy in HIV infection. It occurs mainly in patients with advanced immunosuppression and may also result from the neurotoxicity of several antiretroviral agents. Myopathy may occur at any stage of HIV disease and has also been described as a toxic side effect of zidovudine. Here we review the clinical features, diagnostic approach, and pathogenetic mechanisms of the neuromuscular complications of HIV infection. We also discuss management strategies and the results of clinical trials for the treatment of these disorders.

Peripheral neuropathy in HIV disease.

AIDS: Neurologic disorders are a devastating and common complication of HIV infection and are likely to become more prevalent as patients survive longer. Nerve disorders common to HIV include distal symmetric polyneuropathy (DSP), inflammatory demyelinating polyneuropathy (IDP), mononeuritis multiplex (MM), progressive polyradiculopathy (PP), and autonomic neuropathy (AN). The debilitating pain associated with each of these syndromes can severely impact the quality of life of a patient. Each syndrome is described, including information on the syndrome's causes and possible treatments.^ieng