Abstract
This report describes a man in his 40s who presented at a psychiatric clinic with depressive symptoms and sensitivity. About one year later, he was admitted to our psychiatric department because he developed cognitive disorder, doppelganger-like symptoms, delirium, incontinence and gait disturbance. After admission to our department, he was found to be infected with HIV. A subsequent magnetic resonance imaging (MRI) revealed age-inappropriate brain atrophy and diffuse lesions with high intensity in the cerebral white matter. These MRI findings triggered suspicion of a diagnosis of HIV-associated neurocognitive disorder (HAND). HIV wasting syndrome was considered to be the cause of delirium in the patient, because his delirium resolved after hospitalization and improvement in his physical condition. However, cognitive disorder persisted after the delirium resolved. No other central nervous system infections or organic brain disorders were found in the patient. Therefore, he was diagnosed with HAND. Antipsychotic medication and antiretroviral therapy improved his psychiatric symptoms and cognitive disorder, but the size of the lesion in the white matter increased. These findings suggest that psychiatrists should consider the possibility of HAND when patients present with psychiatric symptoms in the absence of a diagnosis of HIV infection. When diagnosing HAND, age-inappropriate brain atrophy and cerebral white matter lesions on brain MRI are considered to important findings.
