Objective: We hereby report a case of subacute onset progressive pancerebellar ataxia, which after a thorough workup, turned out to be a primary manifestation of HIV.

Background: Broadly, ataxia can be sensory or cerebellar. Evaluation for the etiology of cerebellar ataxia depends primarily upon its onset and rapidity of progression. Subacute onset cerebellar ataxia usually has a paraneoplastic, toxic, tubercular, or hypovitaminosis etiology. HIV has rarely been reported to cause cerebellar ataxia as its 1^st manifestation and thus, is not the usual suspect in evaluation for cerebellar ataxia.

Method: A 40 year old gentleman from rural India, presented with 3 month history of insidious onset progressive pan-cerebellar syndrome in form of truncal and appendicular ataxia, ataxic dysarthria, intention tremor in both upper limbs, and dysmetric saccades. There was no cognitive impairment. There was neither a history of toxin exposure, weight loss, fever, or promiscuity, nor any family history of ataxia. MRI Brain showed mild pan-cerebellar atrophy. A thorough workup was negative for paraneoplastic syndrome, toxin/vitamin related disorder, tuberculosis, meningoencephalitis, JC virus, & sensory ataxia. With workup almost reaching a futile end, HIV-1 rapid and Western blot test came out positive. CD 4 count was 450.

Results: Thus, patient was diagnosed as a case of HIV 1 with cerebellar ataxia as primary manifestation. He was started on anti-retroviral therapy. On follow-up at 1 month now, he has shown subtle improvement in his cerebellar syndrome.

Conclusion: HIV can result in a variety of neurological syndromes, but cerebellar ataxia as isolated presentation has rarely been reported and thus, a very limited data exists on its adequate management. Our case stresses the fact that HIV should be excluded in patients with subacute onset cerebellar ataxia, even in the absence of other neurological or systemic manifestations of HIV. These cases deserve recognition as publication, so that appropriate guidelines can be formulated to diagnoses and treat them.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/cerebellar-ataxia-as-primary-manifestation-of-hiv-a-rare-etiological-association/