When a man with untreated human immunodeficiency virus (HIV) infection presented with recurrent episodes of syncope, magnetic resonance imaging (MRI) yielded a novel etiology.
The patient, a 51-year-old Puerto Rican man, presented to our clinic with cough, hemoptysis, night sweats, and recurrent syncopal episodes. He described intermittent episodes of fainting, increasing in frequency, for 3 months prior to presentation. In the previous week alone, he had suffered 3 such episodes. His daughter, who had witnessed several of the fainting episodes, had called for emergency medical services after his most recent episode, which had resulted in a fall. She reported that the syncopal episodes were accompanied by convulsions during and after loss of consciousness and by a period of confusion after regain of consciousness. The episodes were not accompanied by bowel or bladder incontinence.
The patient had been diagnosed with HIV in 1994 but had no history of acquired immune deficiency syndrome (AIDS)-defining illnesses. He had discontinued his antiretroviral therapy in 2003 because of pill burden. His medical history was otherwise significant for a severe burn to the lumbar spine, which had left him paraplegic and wheelchair-bound at baseline.
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— Brian Hollenbeck, MD, Samir Dalia, MD, Kelly McGarry, MD
This article originally appeared in the September 2010 issue of The American Journal of Medicine.
