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Neurol Sci. 2010 Oct;31(5):661-3. doi: 10.1007/s10072-010-0355-9. Epub 2010 Jun 22.

Bilateral Holmes-Adie syndrome as an early manifestation of the HIV neuropathy.

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Department of Neurology, 2nd Medical Faculty, Charles University in Prague, Prague, Czech Republic.


A 38-year-old HIV-1 infected woman affected with bilateral tonic pupils. Ophthalmologic examination confirmed Holmes-Adie syndrome (HAS), and peripheral distal polyneuropathy, orthostatic hypotension and leg hyperhidrosis were detected on further workup. The HAS can be either idiopathic or associated with neuropathy of various etiology (autoimmune, paraneoplastic and infectious). In our patient, the pupillotonia was the first and early symptom of hitherto unrecognized HIV neuropathy. HAS has been previously observed in association with syphilis, Lyme borreliosis, herpes simplex and parvovirus B19 infection. Our case is the first report of HAS in a case of HIV infection.

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