Opsoclonus-myoclonus-ataxia syndrome in an ART-naïve patient with CSF/plasma HIV-1 RNA discordance

Opsoclonus-myoclonus-ataxia syndrome (OMAS) is a rare neuroimmunological disorder with diverse etiologies, including infection-associated triggers such as human immunodeficiency virus (HIV) infection. Herein, we report a case of HIV-associated OMAS in an antiretroviral therapy (ART)-naïve patient who presented with cerebrospinal fluid (CSF)/plasma HIV-1 RNA discordance. A 16-year-old female was diagnosed with HIV following the onset of OMAS. The CSF HIV-1 RNA level was higher than that in the plasma. After ART initiation, both the CSF HIV viral load and OMAS symptoms improved simultaneously. This case demonstrates that CSF/plasma HIV-1 RNA discordance can occur in ART-naïve patients with HIV-associated OMAS. Moreover, our findings suggest that, in such cases, viral suppression through ART alone may be sufficient to achieve clinical resolution without the need for adjunctive immunosuppressive therapy.