OPSOCLON-MYOCLON SYNDROME ASSOCIATED WITH INFECTION

Abstract

Opsoclonus-myoclonus syndrome (OMS) is a rare neurological condition characterized by opsoclonus, myoclonus, and ataxia; its presentation in adults necessitates an extensive search for the underlying etiology, including paraneoplastic, infectious, and autoimmune causes. We report the case of a 44-year-old male with HIV infection on antiretroviral therapy who presented with a subacute onset of headache, gait instability, and multidirectional eye movements. Imaging revealed longitudinally extensive myelitis (T5–T9) predominantly affecting the posterior columns, while cerebrospinal fluid analysis showed mononuclear pleocytosis, elevated protein levels, and intrathecal IgG synthesis evidenced by oligoclonal bands. Although the CSF VDRL test was negative, a history of syphilis, a reactive serum VDRL, compatible neurological symptoms, and intrathecal inflammation supported a suspicion of probable neurosyphilis. Relevant differential diagnoses in HIV patients were discussed, including autoimmune demyelinating disorders such as neuromyelitis optica spectrum disorder. The patient was treated with penicillin G and methylprednisolone, showing partial clinical improvement. This case highlights the utility of cerebrospinal fluid analysis in determining the etiology of OMS in HIV patients, as well as the need to integrate epidemiological history, imaging findings, and therapeutic response when facing complex diagnostic scenarios.