Acute encephalopathy and multi-organ involvement with rhabdomyolysis during primary HIV infection

An adolescent male developed encephalopathy and multiple organ involvement with rhabdomyolysis during primary HIV infection (PHI). All symptoms and signs resolved within a few days. Nineteen cases of central nervous system complications (other than aseptic meningitis) have been reported in PHI. These include encephalopathy, meningoencephalitis, acute disseminated encephalomyelitis, multiple sclerosis, myelopathy, and meningoradiculitis. Half of the patients died or suffered sequelae. Except in cases of multiple sclerosis, steroids were not of benefit. Initiation of antiretrovirals during PHI remains controversial. Rhabdomyolysis was reported in eight patients with PHI. All patients recovered. Primary HIV infection should be considered when the clinician faces patients with unexplained neurologic manifestations, rhabdomyolysis, or multiple organ involvement.