Longitudinal extensive transverse myelitis as the initial manifestation of the acquired immunodeficiency syndrome

Introduction: Longitudinal extensive transverse myelitis (LETM) is characterized by the inflammation of three or more vertebral segments. It is not a common entity, and it is even more rare as the initial manifestation of acute HIV infection. Case presentation: A previously healthy 28-year-old male presented with progressive quadriparesis associated with spasticity and hyperreflexia. Spinal MRI showed hyperintensity of spinal levels T3 through T12, compatible with longitudinal extensive transverse myelitis; HIV serology was later found to be reactive, as well as positive polymerase chain reaction (PCR) for Epstein-Barr virus (EBV) in cerebrospinal fluid (CSF). Given that extensive workup ruled out opportunistic infections and other possible causes of longitudinal extensive transverse myelitis, the clinical manifestations were attributed to the acute HIV seroconversion. Discussion: Acute transverse myelitis in patients with HIV is an uncommon condition that has only been described in very few case reports during seroconversion. Additionally, the positive polymerase chain reaction  for Epstein-Barr virus in cerebrospinal fluid has uncertain clinical significance in patients with HIV. Conclusion: This case highlights the importance of considering HIV as a potential underlying cause in patients presenting with neurological symptoms, even when classic symptoms of HIV/AIDS are absent. In addition, future studies should aim to explore the real importance of Epstein-Barr virus positivity in cerebrospinal fluid to improve management strategies and possible outcomes.