Acute Dysautonomia: A Rare Cause of Mortality in AIDS Encephalopathy -A Case Report and Review of Literature

Abstract

Introduction: Acute dysautonomia is a dysfunction of the autonomic system which can be caused by any diffuse systemic illness or a structural pathologic process of the brain
Aims and objectives: To describe the clinical presentation and outcome of acute dysautonomia on the background of AIDS encephalopathy. Methods and material: This is a hospital-based case report of acute dysautonomia in a 60 year old man who was diagnosed HIV-1 positive in 2001, but stopped his antiretroviral drugs in 2009 after 6 years of therapy. The patient presented with irrational behaviour and confusion of one year duration, generalised abdominal pains and constipation of 6 weeks duration, and labile blood pressures, pulses and temperatures few days prior to his demise. . He had no pre-morbid medical or psychiatric illness and neither smoked cigarette nor ingested alcohol. Results: At presentation, systemic examination was normal, except the central nervous system which revealed mini-mental score of 6/30 points and modified HIV dementia score of 5/12 points, necessitating a diagnosis of AIDS dementia complex. On the 14th day of admission, he developed acute autonomic syndrome and despite resuscitative measures, died of cardiac arrest within 48 hours. Conclusion: Acute dysautonomia is a rare complication of AIDS encephalopathy which has a fatal outcome.