Mononeuritis multiplex is characterised by the acute onset of one or more nerve palsies. The likely underlying cause of mononeuritis multiplex varies at different stages of HIV disease. A relatively benign form of mononeuritis multiplex occurs early in the course of HIV infection, and commonly resolves spontaneously (76,77). In patients with moderate immunosuppression (CD4 count 200-500 cells/mm3), mononeuritis multiplex may be related to immune complex disease secondary to hepatitis B virus (HBV), hepatitis C virus (HCV), vasculitis or malignancy either by infiltrative or paraneoplastic mechanisms (76,77). In advanced HIV disease (CD4 count < 200 cells/mm3), mononeuritis multiplex is more likely to be due to nervous system involvement with an opportunistic infection, most commonly CMV.(76–78)
A presumptive diagnosis of mononeuritis multiplex can be made on clinical findings, but investigations should include serology tests for HBV, HCV, CMV, HSV, VZV and a serum quantitative CMV DNA PCR. CSF investigations include cytology, flow cytometry, and polymerase chain reaction (PCR) assays on the CSF for CMV, VZV and HSV. Other aetiologies of mononeuritis multiplex should be evaluated including diabetes, vasculitis.
Therapy for mononeuritis multiplex is directed towards the underlying mechanism, e.g. Ganciclovir for CMV or chemotherapy for malignancy, in addition to effective cART therapy (76–78).
Further recommended reading
Brew BJ. HIV Neurology. Contemporary Neurology Series Oxford University Press 2001.
Brew BJ. The Neurology of HIV Infection. Handbook of Clinical Neurology Elsevier Press 2018.