Human Immunodeficiency Virus-Associated Vasculitis: A Case Report of Sensorineural Hearing Loss, Bell's Palsy, and Psoriasis Guttata

Human immunodeficiency virus (HIV) infection can manifest with diverse and nonspecific symptoms, often delaying diagnosis. Neurological and autoimmune complications have been associated with HIV-induced immune dysregulation. Although HIV-associated vasculitis is rare, its recognition is crucial due to its potential impact on disease progression and management. We report the case of a 62-year-old woman who was initially referred to the autoimmune disease clinic for evaluation of left-sided sensorineural hearing loss (SNHL), which had been fluctuating for two years and showed a response to corticosteroids. One year before the consultation, she developed Bell’s palsy, which was thought to be postviral and resolved with corticosteroid therapy. Over time, she experienced recurrent upper respiratory infections and low-grade fevers. After the first consultation, the patient developed dispersed skin lesions suggestive of psoriasis guttata and cervical and submandibular lymphadenopathy. Laboratory investigations confirmed HIV-1 infection, and the positron-emission tomography computed tomography imaging revealed widespread hypermetabolic lymphadenopathy and active aortic vasculitis, suggesting an inflammatory process related to HIV. Antiretroviral therapy (ART) with dolutegravir/lamivudine was initiated. During early treatment, her psoriasis resolved completely, and there was no recurrence of hearing loss or Bell’s palsy. HIV-associated vasculitis is an infrequent but clinically significant manifestation that can affect vessels of various sizes. The pathogenesis involves direct endothelial damage by HIV, immune complex deposition, and a proinflammatory cytokine cascade. This case suggests that fluctuating SNHL and Bell’s palsy may have resulted from small-vessel vasculitis or direct viral nerve damage, with aortitis further supporting the presence of systemic vascular inflammation. Additionally, psoriasis guttata, emerging during acute HIV infection, was likely driven by immune activation and cytokine dysregulation. The resolution of psoriasis and stabilization of symptoms after ART initiation highlight the central role of immune restoration in mitigating inflammatory manifestations. This case underscores the need for a high index of suspicion for HIV in patients presenting with multisystemic inflammatory conditions. The identification of HIV-associated vasculitis is rare and requires detailed clinical assessment and imaging. The multidisciplinary approach involving otorhinolaryngology, autoimmune disease, and infectious disease was essential for reaching a diagnosis in a timely manner and optimizing patient outcomes. ART remains the cornerstone of treatment, controlling viral replication, reducing immune dysregulation, and improving systemic inflammation. Early diagnosis and prompt initiation of ART play a critical role in preventing complications and ensuring a favorable long-term prognosis.