Regression Of A Cervical Spinal Mass Following Highly Active Antiretroviral Therapy (haart) In Child With Advanced Human Immunodeficiency Virus (hiv) Disease
Leng, L. K., Pancharoen, C., Bunupuradah, T., Thisyakorn, U., Trinavarat, P., Sosothikul, D., & Ananworanich, J. (2007). Regression of a cervical spinal mass following highly active antiretroviral therapy (HAART) in child with advanced human immunodeficiency virus (HIV) disease. Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 90(9), 1937–1942.
View Original Source →Abstract
This report documents a case of infiltrating cervical spinal mass, most likely a spinal tumor, in a girl with HIV infection that regressed following HAART and without treatment of the tumor or any anti-infectives.
Case Details
Disease Location
Spinal
Personal Characteristics
7 -year-old thai female september 2003 mother was diagnoses with HIV during pregnancy, both patient and mother did not receive antiretrovial (arv) treatment to prevent mother-to-child transmission. Patient was not breast fed. She had an older sister whom passed away at 8 -year-old due to crypatientococcal meningitis. Patient was diagnosed with HIV at 2 -year-old. She experienced many HIV related illnesses e.g., pneumocistis jiroveci pneumonia at 5 months old, varicella infection at 2 -year-old, recurrent herpes zoster, chronic diarrhea, oral candidiasis and wasting syndrome. Patient was naive to arv treatment
Clinical Characteristics
Presented with left upper extremity weakness. One months prior complained of pain in her neck that radiated to the left shoulder, following that she was unable to lift her left arm to dress herself and had left handgrip weakness. There was also a fever at night during this time. At the initial visit, she was afebrile, cachetic, and pale. Weight 11.5 kg, height, 103 cm. No significant cardiovascular, respiratory, and gastrointestinal findings. Multiple palpable lymph nodes in cervical, axillary, and inguinal regions. She showed good orientation and understood all commands, all cranial nerve functions were normal. Both lower extremities showed grade 4 motor power, normal deep tendon reflexes, no babinski sign and no fasciculation. Right upper extremity had a motor power of grade 4, except proximal part of the left upper extremity was a grade 0 motor power and the distal part was grade 2-3. Deep tendon reflexes were normal in the right upper but not the left upper extremity, no fasciculation. Radiography of the cervical and thoracic spines revealed no abnormalities, it did reveal a tracheal shift to the right at the cervical level and reticular opacities in the upper lobe of the right lung. MRI revealed three lesions, an infiltrating mass, a multiple cervical lymphadenopathy and a pulmonary infiltration in the right upper lobe the infiltrating mass was located at the left paravertebral space, extending from c3 to c6, encasing left vertebral artery, widening the neural foramina and extending into the spinal canal. The left carotid artery and internal jugular wein were laterally displaced. The mass was isodense with muscle on t1, hyperintense on t2 and homogeneously enhanced after gd injection. Lymphadenopathies involved the left lateral retropharyngeal node, bilateral jugular and spinal accessory nodes lab exams revealed hypochromic microcytic anemia (hemoglobin 7.4 gm%, mean corpuscular volume 59, mean corpuscular hemoglobin 17.8), normal white blood cell count, normal platelet count. CD4+ cell count and HIV RNA was unavailable. Leimyosarcome was suspected but open biopsy was postponed because surgeons felt she was too sick. She was discharged and put on close observation, she didnt receive haart at that time. October 10th 2003 was readmitted with an episode of seizure proceeded by high fever. Lumbar puncture was done and lab exam of the csf was found normal and negative for crypatientococcal antigens, she was discharged with a appatient for a follow-up oct 27th 2003, she was started on haart following the 2005 MRI, she followed up in the clinic every 3 months for clinical and CD4 monitoring. Periodic mris were planned.
Remission Characteristics
After haart her clinical, CD4 and HIV-RNA improved. CD4 rapid and sustainable rise, and HIV-RNA was complete suppressed december 2005, follow-up MRI could still visualize the lesion encroaching upon the cervical foramina but had significantly regressed. There was no new lesion. The lesion showed mild homogenous enhancement. Complete resolution of neurological symptoms after response to haart
Treatment & Mechanisms
Proposed Remission Mechanisms
Improvement of the immune system helped control the tumor
Clinical Treatment
Haart with stavudine, lamivudine and nevirapine
Non-Clinical Treatment
None reported