HIV in Children
GRAND ROUNDS AND TEACHING FILES
ACUTE ONSET ENCEPHALOPATHY
Ira Shah
Consultant in Pediatric Infectious Diseases and Pediatric Hepatology, Nanavati Hospital, Mumbai, India
Incharge, Pediatric HIV and TB Clinic, B J Wadia Hospital for Children, Mumbai, India

One and a half years old boy born of non-consanguineous marriage presented with fever, convulsion and altered sensorium for 4 days. The child had undergone circumcision under general anesthesia 4 days ago following which in next 6 hours, he developed fever, convulsion and unconsciousness. The convulsion was left focal with repeated episodes. There was no rash, and milestones were normal. On examination, he had left focal convulsion, hypertonia with brisk reflexes and extensor planters. There was no neck stiffness. Other systems were normal. Cerebrospinal fluid (CSF) examination showed 5 lymphocytes/cumm with occasional RBCs and normal sugar and proteins. EEG showed pleds. MRI brain showed hyperdensities in right temporoparietal, bilateral frontal and occipital lobes with bilateral temporal hemorrhage. Hemogram, renal function test, blood gases, serum ammonia and electrolytes were normal. He had elevated liver enzymes [SGOT = 249 IU/L, SGPT = 99 IU/L]. CSF herpes simplex (HSV) PCR was negative. He was treated with multiple anticonvulsants, acyclovir to which his seizures responded. However, he continues to have spasticity and is not yet oriented to the surrounding.

What is the diagnosis?
See Previous Teaching Files
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