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Multiple cranial neuropathy and HIV-2

The peripheral nervous system is frequently involved in different stages of HIV-1 infection. Cranial neuropathies have already been described in HIV-1 patients, but never in HIV-2 patients. We describe the first case of multiple cranial neuropathy associated with, and presumably due to HIV-2 itself.

A 25 year old heterosexual white man was referred to our hospital for evaluation of a left facial palsy of insidious onset in the previous days. He complained of hoarseness and episodic horizontal diplopia for the previous 2 months. Past medical history was unremarkable except for an episode of hospitalisation at 3 weeks of age, when he underwent several blood transfusions.

Physical examination was normal except for diffuse tonsillar enlargement. Neurological examination disclosed anisocoria RE>LE, horizontal diplopia on left side gaze without clear evidence of oculomotor palsy, hypoesthesia of the left V3 territory, left peripheral facial palsy, left hypoacusia, bilateral decreased gag reflexes, and dysphonia.

Brain MRI (fig 1A, B) showed enlargement and gadolinium enhancement of the intracranial third (bilateral), fifth (right) and intracanalicular seventh …