HIV Encephalitis Presenting as Epilepsia Partialis Continua

Seizures in human immunodeficiency virus (HIV)-positive patients can be a consequence of opportunistic infections, neoplasms, or HIV encephalopathy. We report a case of a 21-year-old boy, with no premorbid illnesses, presenting with epilepsia partialis continua (EPC). Magnetic resonance imaging (MRI) brain showed bihemispherical cortical lesions and was detected to be HIV positive. He showed good clinical improvement with intravenous immunoglobulins and multiple antiepileptic drugs. The present case has several peculiarities. This case presented with EPC with secondary generalization. There was worsening of sensorium with refractory status epilepticus, necessitating endotracheal intubation, intravenous benzodiazepine infusion, intravenous immunoglobulins, and four antiepileptic drugs. He made uneventful clinical recovery over 3 weeks’ period. The previously reported case series in literature have not shown significant change in outcomes with treatment. Treatment with intravenous immunoglobulins in this setting has not been previously described. Initiation of immunomodulation along with aggressive antiretroviral therapy (ART) plays an important role in clinical profile suggestive of EPC and HIV infection. Sequential MRI imaging of brain showed progressive increase in distribution of lesions, initial imaging showing right precentral gyral thickening, which were nonenhancing followed by signal changes in the left corticospinal tract as well as changes in the subcortical region (globus pallidus) and cerebellar hemisphere. Cerebrospinal fluid polymerase chain reaction was negative for herpes simplex virus, cytomegalovirus (CMV), John Cunningham virus, Pneumococcus, and Cryptococcus. These lesions were noncontrast enhancing, hyperintense on T2/fluid-attenuated inversion recovery, and no significant change on T1 sequence (unlike lesions in progressive multifocal leukoencephalopathy [PML]). These signal changes have not been previously reported in HIV-related encephalitis. HIV-related cortical lesions can be due to CMV, Toxoplasma, lymphoma, and PML. Previously reported case from All India Institute of Medical Sciences (AIIMS), EPCs were secondary to CMV-related encephalitis in HIV (MRI brain showing signal changes in parieto-occipital cortex and thalamus). The present case has shown that early initiation of immunomodulation along with antiepileptic drugs was helpful in bringing excellent outcomes. Publication History Article published online: 15 July 2026 © 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/) Thieme Medical and Scientific Publishers Private Limited A-13A, Graphix Tower 1, 6th floor, Sector 62, Noida 201309, Uttar Pradesh, India