Stroke in an adult with HIV infection due to carotid artery stenosis successfully treated with steroids: HIV-associated arteritis?

A 33-year-old Caucasian man with a 17-year history of HIV infection developed sudden right-sided hemiplegia, with the arm more affected than the leg, and aphasia. Magnetic resonance imaging of the brain showed hemodynamic watershed stroke between the anterior and middle cerebral artery territories and an ischemic stroke within the left posterior middle cerebral artery territory. Color-coded Duplex sonography and Doppler sonography revealed hypoechogenic stenosis of the left common carotid artery, the left internal carotid artery, left external carotid artery and right internal carotid artery. An extensive diagnostic workup led us to hypothesize that HIV-associated arteritis was the cause of the stroke, and following intravenous steroid therapy, the carotid artery stenoses vanished.