1534 - Gait, cognitive, and visual impairments in the setting of acquired immunodeficiency syndrome, status epilepticus, suspected immune reconstitution inflammatory syndrome, and posterior reversible encephalopathy syndrome.

Friday, February 23, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

SC

Sovanndy Cheav, DO

Resident
NW Marianjoy Rehabilitation
Wheaton, Illinois, United States

Corresponding Author(s)

MM

Mohammed Y. Mirza, n/a

Medical Student
Rosalind Franklin University of Medicine and Science
Elmhurst, Illinois, United States
JW

Julie E. Witkowski, MD

Attending physician
Marianjoy Rehabilitation Hospital
Wheaton, Illinois, United States

Case Diagnosis:
Posterior reversible encephalopathy syndrome (PRES) 

Immune reconstitution inflammatory syndrome (IRIS) 

Human immunodeficiency virus (HIV) 

Acquired immunodeficiency syndrome (AIDS) 

Case Description: A 25-year-old female with HIV/AIDS presented to a acute care facility for headaches, back pain, and chills, complicated by seizure/status epilepticus. MRI brain showed T2/FLAIR hyperintensity prominent in the bilateral occipital and parietal lobes suggestive of PRES. The patient was treated for disseminated histoplasmosis/CMV viremia and there was suspicion for IRIS. She was maintained on medical therapy with foscarnet/itraconazole/biktarvy and started on dexamethasone taper for suspected IRIS. She demonstrated impairments in balance, cognition, and vision, and was admitted to inpatient rehabilitation.

Discussions: The patient presented with complications secondary to status epilepticus, PRES, and IRIS including gait imbalance, cognitive decline, and visual disturbances. Speech therapy evaluation identified cognitive-communication deficits including impaired attention, thought organization, insight, executive function, and processing.  Through the multi-disciplinary approach available in an inpatient rehabilitation setting, patient was followed and managed by physical, occupational, and speech therapies, neuropsychology, Optometry, Infectious Disease, and Physiatry. Throughout her rehab stay our patient demonstrated improvement in mobility with progression to a supervision level for all ADLs, She reported resolution of visual impairment, and cognitive testing demonstrated a Montreal Cognitive Assessment (MOCA) score improving from 19/30 on admission to 28/30 on discharge.

Conclusions: A literature review of status epilepticus, PRES, IRIS, and rehabilitation is limited. Though these pathologies have been studied individually, the combination of these disease states in the setting of rehabilitation has not been examined. This case study demonstrates the benefit of a multidisciplinary inpatient rehabilitation approach in this medically complex patient presentation. 