Neurological Sciences

, Volume 31, Issue 5, pp 661–663 | Cite as

Bilateral Holmes–Adie syndrome as an early manifestation of the HIV neuropathy

  • Rudolf Cerny
  • Hanus Rozsypal
  • Pavel Kozner
  • Ladislav Machala
Case Report


A 38-year-old HIV-1 infected woman affected with bilateral tonic pupils. Ophthalmologic examination confirmed Holmes–Adie syndrome (HAS), and peripheral distal polyneuropathy, orthostatic hypotension and leg hyperhidrosis were detected on further workup. The HAS can be either idiopathic or associated with neuropathy of various etiology (autoimmune, paraneoplastic and infectious). In our patient, the pupillotonia was the first and early symptom of hitherto unrecognized HIV neuropathy. HAS has been previously observed in association with syphilis, Lyme borreliosis, herpes simplex and parvovirus B19 infection. Our case is the first report of HAS in a case of HIV infection.


Holmes–Adie syndrome Tonic pupil Areflexia HIV Polyneuropathy 


  1. 1.
    Martinelli P (2000) Holmes–Adie syndrome. Lancet 356:1760–1761CrossRefPubMedGoogle Scholar
  2. 2.
    Kawasaki A (2005) Disorders of pupillary function, accommodation, and lacrimation. In: Miller N, Newman N (eds) Clinical neuro-ophthalmology, vol 1. Lippincott, Philadelphia, pp 739–805Google Scholar
  3. 3.
    Antonio-Santos AA, Santo RN, Eggenberger ER (2005) Pharmacological testing of anisocoria. Exp Opin Pharmacother 6(12):2007–2013CrossRefGoogle Scholar
  4. 4.
    Martinelli P, Minardi C, Cuicci G, Dalpozzo F, Giulani S, Scaglione C (1999) Neurophysiological evaluation of areflexia in Holmes–Adie syndrome. Neurophysiol Clin 29:255–262CrossRefPubMedGoogle Scholar
  5. 5.
    Ford P, Barnes P, Usmani O (2007) Chronic cough and Holmes–Adie syndrome. Lancet 369:342CrossRefPubMedGoogle Scholar
  6. 6.
    Flach AJ, Dolan BJ (1985) The therapy of Adie’s syndrome with dilute pilocarpine hydrochloride solutions. J Ocul Pharmacol 1(4):353–362CrossRefPubMedGoogle Scholar
  7. 7.
    Flach AJ, Dolan BJ (1984) Adie’s syndrome: a medical treatment for symptomatic patients. Ann Ophthalmol 16(12):1151–1154PubMedGoogle Scholar
  8. 8.
    Bremner F, Smith S (2007) Bilateral tonic pupils: Holmes–Adie syndrome or generalised neuropathy? Br J Ophtalmol 61(12):1620–1623CrossRefGoogle Scholar
  9. 9.
    Vermersch P, Dufourd-Delalande S, Defoort-Dhellemmes S, Stojkovic T, Launay D, de Seze J (2005) Tonic pupils in Sjögren’s syndrome. Rev Neurol (Paris) 161(10):963–966Google Scholar
  10. 10.
    Vetrugno R, Liguori R, Cevoli S, Salvi F, Montagna P (1997) Adie’s tonic pupil as a manifestation of Sjögren’s syndrome. Ital J Neurol Sci 18(5):293–295CrossRefPubMedGoogle Scholar
  11. 11.
    Anzai T, Uematsu D, Tahashi K, Katayama T (1994) Guillain–Barré syndrome with bilateral tonic pupils. Intern Med 33:248–251CrossRefPubMedGoogle Scholar
  12. 12.
    Csak T, Folhoffer A, Horvath A et al (2006) Holmes–Adie syndrome, autoimmune hepatitis and celiac disease: a case report. World J Gastroenterol 12(7):1485–1487PubMedGoogle Scholar
  13. 13.
    Morelli N, Gallerini S, Cafforio G et al (2006) Adie tonic pupil associated to endometriosis. Neurol Sci 27:80–81CrossRefPubMedGoogle Scholar
  14. 14.
    Muller NG, Prass K, Zschenderlein R (2005) Anti-Hu antibodies, sensory neuropathy, and Holmes–Adie syndrome in a patient with seminoma. Neurology 64(1):164–165PubMedGoogle Scholar
  15. 15.
    Maitland C, Scherokman B, Schiffman J, Harlan J, Galdi A (1985) Paraneoplastic tonic pupils. J Clin Neurophthalmol 2:99–104Google Scholar
  16. 16.
    Stricker R, Winger E (2001) Holmes–Adie syndrome and Lyme disease. Lancet 357:805CrossRefPubMedGoogle Scholar
  17. 17.
    Lowenstein O, Loewenfeld I (1965) Pupillotonic pseudotabes (syndrome of Marcus-Weill and Reys-Holmes-Adie). A critical review of the literature. Surv Ophthalmol 10:129–185PubMedGoogle Scholar
  18. 18.
    Yasaki S, Ohshima J, Yonekura J, Takahashi Y, Someya K (1992) A case of early syphilis presenting general paresis-like symptoms and bilateral tonic pupils. Rinsho Shinkeigaku 32(9):994–999PubMedGoogle Scholar
  19. 19.
    Richwien R (1990) Iridoplegia-areflexia syndrome (Weill/Reys–Holmes–Adie), symptoms and etiology as persistent herpes simplex virus infection. Fortschr Neurol Psychiatr 58(10):375–379CrossRefPubMedGoogle Scholar
  20. 20.
    Sacktor N (2002) The epidemiology of Human immunodeficiency virus-associated neurological diseases in the era of highly active antiretroviral therapy. J Neurovirol 8(Suppl 2):115–121CrossRefPubMedGoogle Scholar
  21. 21.
    Roig C, Iranzo A (1996) Visual and central oculomotor disorders in patients with acquired immunodeficiency syndrome. Rev Neurol 136:1597–1604Google Scholar
  22. 22.
    Torras-Sanvicens J, Arruga-Ginebreda J (1996) Optic neuropathies and peripheral oculomotor disorders in patients with AIDS. Rev Neurol 136:1605–1613Google Scholar
  23. 23.
    Maclean H, Dhillon B (1993) Pupil cycle time and human immunodeficiency virus (HIV) infection. Eye 7(Pt 6):785–786PubMedGoogle Scholar
  24. 24.
    Nagata Y, Fujino Y, Matsumoto S et al (1993) Ocular manifestations in Japanese patients with human immunodeficiency virus infection. Jpn J Ophthalmol 37(3):275–281PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Rudolf Cerny
    • 1
  • Hanus Rozsypal
    • 2
  • Pavel Kozner
    • 3
  • Ladislav Machala
    • 4
  1. 1.Department of Neurology, 2nd Medical FacultyCharles University in PraguePragueCzech Republic
  2. 2.Department of Infectious and Tropical Diseases, First Faculty of Medicine, University Hospital BulovkaCharles University in PraguePragueCzech Republic
  3. 3.Department of OphthalmologyUniversity Hospital BulovkaPragueCzech Republic
  4. 4.1st Department of Infectious Diseases, 2nd Faculty of Medicine and Department of Infectious Diseases, Third Faculty of MedicineCharles University in PraguePragueCzech Republic

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