Acute HIV Infection Masquerading as Idiopathic Intracranial Hypertension: A Case Report and Literature Review

Abstract

We describe a previously healthy 21-year-old man who presented acutely with signs and symptoms of raised intracranial pressure (ICP). Lumbar puncture yielded an elevated opening pressure and an acellular CSF analysis. Radiological images showed bilateral flattening of the posterior eye globes and an empty sella turcica. His serum HIV antigen/antibody was reactive. We provide a review of published cases that have been labeled as idiopathic intracranial hypertension (IIH) in HIV-infected patients, addressing the appropriateness of labeling such cases as truly idiopathic. We also discuss the importance of a thorough clinical evaluation of raised ICP in those who do not fulfil the typical IIH demographic.

Keywords: Acellular CSF; Acute HIV infection; Aseptic meningitis; Idiopathic intracranial hypertension; Raised intracranial pressure.

Fig. 1

a Fundus photographs at initial presentation: bilateral grade III papilledema. b Fundus examination revealed worsening papilledema with hemorrhages and exudates. c Fundus examination after ventriculoperitoneal shunt placement revealed improvement of previous edema.

Fig. 2

a Visual field test showed bilateral inferior arcuate defects and enlarged blind spot OS. b Visual field test showed an improvement in the size of the blind spot OS and the inferior arcuate defect.