ABSTRACT A 34-year-old man presented with a history of 21-days of gait unsteadiness and diplopia. Ten days before presentation, he developed limb weakness and in the last three days reduced consciousness. HIV infection was diagnosed three months ago (CD4+ = 160 cells/ mm3; viral load HIV-1 = 144.000 copies/mL), and antiretroviral therapy was initiated. Impaired consciousness, ophthalmoplegia, limb weakness, ataxia, areflexia, and Babinskys sign were noted. At that moment, CD4+ count was 372 cells/mm 3 and viral load HIV-1 < 50 copies/mL. The clinical, laboratory and neurophysiological findings suggest overlapping Guillain-Barré syndrome (GBS) and Bickerstaff brainstem encephalitis as manifestation of HIV-related immune reconstitution inflammatory syndrome (IRIS). Here, we review and discuss 7 cases (including the present report) of GBS spectrum as manifestation of HIV-related IRIS.

Apresentamos dois casos de histoplasmose em que o acometimento do sistema nervoso central foi a única manifestação clínica da doença. Revisão da literatura permitiu confirmar a raridade dessa forma de patologia, em particular em crianças, sendo o segundo caso aqui apresentado o de mais baixa idade na literatura nacional. São feitos comentários sobre a variedade das apresentações clínicas e os principais diagnósticos diferenciais da doença. São discutidos os resultados laboratoriais, tanto em relação às alterações liquóricas quanto aos resultados sorológicos. Finalmente, é analisada a terapêutica dessa forma de infecção fúngica tanto em relação aos medicamentos utilizáveis quanto à duração prolongada aconselhável para o tratamento específico.

We present two patients with central nervous system involvement as the unique clinical manifestation of histoplasmosis. A clinical review confirmed the infrequency of this form of the disease, overall in childhood, being one of these cases the youngest in Brazilian reports. Comments about the diversity of clinical presentation and main differential diagnosis are presented. We analyze the serologic and cerebrospinal fluid results and, finally, discuss the drugs and duration of treatment.