Opsoclonus myoclonus syndrome in an HIV patient, following plasmodium falciparum infection.

Opsoclonus myoclonus syndrome (OMS) is a rare inflammatory disease of the central nervous system characterized by ocular movements, ataxia, irritability, myoclonus, and sleep disturbances and is thought to result from variable etiologies. We report a case of OMS following severe malaria in a patient living with Human Immunodeficiency Virus (HIV). This is a 47-year-old woman, known to be HIV-positive, for the past 6 years, and on highly active antiretroviral therapy (HAART) with Tenofovir-Lamivudine-Atazanavir, to which she is strictly compliant. Her last viral load was undetectable. Two weeks after being treated for severe malaria due to Plasmodium falciparum, the patient presented with multidirectional ocular saccades associated with trunk myoclonus. This was subsequently followed by aggressive behavior sleep disturbances, and severe ataxia. The diagnosis of post-infectious opsoclonus-myoclonus was made after ruling out an HIV-related central nervous system (CNS) infection and a paraneoplastic origin. Initial management consisted of high doses of intravenous (IV) methylprednisolone which resulted in partial improvement of the symptoms. The subsequent addition of rituximab led to complete resolution of the symptoms and the restoration of functional autonomy. This case suggests a possible relationship between malaria and OMS in the context of HIV infection and highlights the potential benefit of an IV corticosteroid and rituximab combination therapy as a substitute for IV immunoglobulins in resource-limited settings.