Sphenoidal Meningioma with Focal Seizures Masquerading as Immune Reconstitution Inflammatory Syndrome in HIV Patient.
Samwel Sylvester Msigwa, Given Kihaga
✦ AI-curated · Sources linked
Case in brief
A 47-year-old woman with HIV developed recurrent focal-onset seizures progressing to bilateral tonic-clonic seizures about 4 weeks after starting antiretroviral therapy. Examination was unremarkable, and EEG showed left anterior temporal slowing. Testing for Toxoplasma gondii, Cryptococcus neoformans and Mycobacterium tuberculosis was negative. MRI demonstrated a 3.0 cm × 4.3 cm well-circumscribed extra-axial mass over the left sphenoid wing, with vasogenic oedema and midline shift, consistent with meningioma. Antiseizure medication controlled the seizures; gross total resection was performed, and she remained seizure-free at 12 months.
What made this case unusual
The timing after antiretroviral therapy initially suggested CNS immune reconstitution inflammatory syndrome, but the seizures were associated with a sphenoidal meningioma rather than an infectious or inflammatory process.
Diagnostic / clinical pearl
In adults with HIV who develop seizures after starting antiretroviral therapy, do not assume IRIS; integrate infectious testing, EEG and brain imaging to assess for a treatable structural cause.