Cerebral aneurysms in a child with acquired immune deficiency syndrome during rapid immune reconstitution

A 12-year-old boy with perinatally acquired human immunodeficiency virus infection and Centers for Disease Control and Prevention class C3 disease presented with acute onset of confusion and a right-sided movement disorder 5 months after beginning a new antiretroviral regimen. His CD4 count had been below 50 cells/muL for 4 years but had abruptly risen to more than 250 cells/muL. Computed tomographic and magnetic resonance imaging scans showed cerebral aneurysms and new cerebral lesions consistent with ischemic strokes. The presentation during immune reconstitution suggests that cerebral aneurysms in pediatric patients with acquired immune deficiency syndrome can result from an immune-mediated response to chronic vascular infection.