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24 year old male with known history of AIDS with recent initiation of highly active antiretroviral therapy (HAART) was evaluated for a two days history of diarrhea and generalized weakness. Neurological exam revealed  slow saccadic movements on both horizontal and vertical gaze, dyssenergia in bilateral lower extremity with dysmetria in all extremities with motor exam significant for paraparesis with hyperreflexia in lower extremity. Significant laboratory findings revealed sodium of 131 meq/L and a CD4 count of 151. CSF testing was non-revealing with negative viral, bacterial and parasitic titres  MRI revealed diffusion restriction involving the pons suggestive of a central pontine myelinolysis. 

On literature review CPM has been found on autopsy of AIDS patient and there have been seven
reported cases of patients with diagnosed HIV/AIDS presenting with symptoms/imaging consistent with central pontine myelinolysis. Rapid correction of hyponatremia which is considered to be one of the main culprits for CPM was absent in all of these cases. Two of the patients had Kaposi sarcoma in
addition to HIV. One patient had concomitant CMV and toxoplasmosis  infection. Two of the cases had mild hyponatremia similar to our patient. Two of the cases did not have any classic risk factors associated with CPM with one of the patient having Castleman’s disease who was reported to have full recovery. 

It is interesting to note that these prior reported  cases had AIDS  on presentation who were either not on therapy or non-compliant. It is unclear if AIDS or underlying immunosuppression is an independent risk factor for CPM and further studies are required to establish causality.