Differential Diagnosis for HIV Positive Patient with Right Thigh Weakness, Burning Pain, and Numbness
- Single Most Likely Diagnosis + Peripheral Neuropathy: This is a common complication in HIV patients, often presenting with symptoms such as weakness, burning pain, and numbness in the extremities. The condition can be directly related to the HIV virus or secondary to antiretroviral drug therapy.
- Other Likely Diagnoses + Lumbar Radiculopathy: Given the localized nature of the symptoms to one thigh, a lumbar radiculopathy (nerve root irritation or damage) could be a plausible explanation. This could be due to a herniated disc, spinal stenosis, or other causes of nerve root compression. + Mononeuritis Multiplex: This condition involves damage to two or more peripheral nerves and can present with asymmetric weakness, pain, and sensory loss. It can be associated with HIV infection, either directly or as part of an immune-mediated process.
- Do Not Miss Diagnoses + Cauda Equina Syndrome: Although less common, this condition is a medical emergency that requires prompt diagnosis and treatment. It involves compression or damage to the cauda equina (the bundle of spinal nerves and spinal nerve roots) and can present with unilateral or bilateral lower limb weakness, pain, and sensory disturbances, along with bowel and bladder dysfunction. + Spinal Cord Compression: This can result from various causes, including metastatic disease, abscess, or epidural hematoma, and is a medical emergency. Symptoms can include progressive weakness, pain, and sensory loss in the lower limbs.
- Rare Diagnoses + Neurosyphilis: In HIV-positive patients, the presentation of syphilis can be atypical, and neurosyphilis (syphilis affecting the central nervous system) can manifest with a wide range of neurological symptoms, including pain, weakness, and numbness. + CMV Radiculopathy: Cytomegalovirus (CMV) infection can cause a radiculopathy in immunocompromised patients, including those with HIV/AIDS, particularly when the CD4 count is very low. This condition can present with severe pain, weakness, and sensory loss in the lower limbs.