Clinical Reasoning: A 33-Year-Old Man With Rapidly Progressive Ataxia

Immunocompromised patients presenting with subacute neurologic deficits pose a diagnostic challenge given the broad differential diagnosis including infections and autoimmune disorders. We describe a 33-year-old man with AIDS who presented with subacute onset of progressive confusion, blurry vision, diplopia, and generalized cerebellar ataxia following hospitalizations for opportunistic infections. This case emphasizes the clinical and diagnostic approach used to refine the differential diagnosis of rhombencephalitis in an immunocompromised patient. Readers will gain an understanding of the various infectious, immunologic, and neoplastic etiologies to consider as well as the interplay between these pathologies.