468 - A Rare Case of Acute Inflammatory Polyneuropathy in the Setting of Parvovirus B19 in a Newly Diagnosed HIV Patient

Case Diagnosis: Acute Inflammatory Polyneuropathy Secondary to Parvovirus B19

Case Description: This is a 57-year-old female who presented with chief complaint of dyspnea, weakness and twenty-pound weight loss. On initial workup, the patient was found to have associated leukopenia with lymphopenia and ground glass opacities on CT chest. Due to clinical suspicion, further workup was done resulting positive for Pneumocystis Jiroveci pneumonia and HIV. During her acute care hospitalization, the patient developed new-onset severe bilateral, ascending lower extremity weakness for which a lumbar puncture was performed showing albuminocytologic dissociation and resulting positive for Parvovirus B19. The patient was treated with IVIG for acute inflammatory polyneuropathy secondary to Parvovirus B19 and was then transferred to acute inpatient rehabilitation.

Discussions: Patients with acute inflammatory polyneuropathy present with bilateral ascending lower extremity weakness, paresthesia, areflexia and is typically associated with viral illnesses such as Campylobacter jejuni, Cytomegalovirus, Epstein Barr virus and Mycoplasma pneumonia. There are few cases in literature discussing this condition in immunodeficient patients with concurrent Parvovirus B19. In immunodeficient patients, the virus continues to replicate causing aplastic anemia but also severe neurological deficits. Due to this, IVIG is utilized as it is effective in symptom mitigation and clearing of viremia from cerebrospinal fluid. From a rehabilitation perspective, therapies that focus on gentle muscle strengthening and sensory reintegration improve prognosis by promoting coordination, mobility, and overcoming functional deficits.

Conclusions: This is a rare case of acute inflammatory polyneuropathy in a patient with newly diagnosed HIV. Although aplastic anemia, arthralgias, and fatigue are the common findings in adults with Parvovirus B19, immunodeficient patients can also present with abnormal sequelae such as acute inflammatory polyneuropathy. Parvovirus B19 should be kept in mind as a possible etiology of acute onset weakness in this patient population so that appropriate treatment and rehabilitation interventions can be implemented.