Treatment challenges for inflammatory demyelinating polyneuropathy in the setting of acute retroviral syndrome: Case report and review of the literature

This is a case of a 20-year-old male with acute retroviral syndrome and concurrent acute inflammatory demyelinating polyneuropathy (IDP) progressing to chronic IDP. Whereas the patient followed a relapsing and remitting course prior to the initiation of antiretroviral therapy (ART), he demonstrated gradual and sustained clinical improvement in the ten months of follow-up after ART was combined with chronic corticosteroids and intermittent plasmapheresis. This case presents and addresses multiple challenges for the treatment of IDP in the setting of acute HIV infection to include: timing of initiation and selection of appropriate ART, the potential risk for immune reconstitution inflammatory syndrome, ART initiation in the setting of severe gastroparesis with jejunostomy placement, and the effect of plasmapheresis on the levels of antiretroviral therapy.