A 41-Year-Old Male with Foot Drop and Malaise

Distal, symmetric polyneuropathy can occur in a number of conditions including in association with HIV infection. The most common neurologic complication of HIV infection is a painful, distal sensory polyneuropathy (HIV-DSP). Other neuromuscular manifestations of HIV are myriad especially in the setting of fluctuating immunocompetence and the potential impact of neurotoxic medications. In the patient described in the case, peroneal neuropathy as the cause for foot drop is suggested by ankle dorsiflexion and eversion weakness with preservation of inversion and knee flexion strength. Mononeuropathy in the setting of HIV should prompt consideration of vasculitic, lymphomatous, and infectious causes, some of which can manifest with systemic findings. A rare neuromuscular complication of HIV-infected patients with sicca symptoms suggestive of Sjogren’s syndrome is diffuse infiltrative lymphocytosis syndrome. This syndrome can manifest as an acute or subacute painful sensory polyneuropathy but also as a mononeuropathy multiplex. This is discussed in the chapter.