We report a case of a 59-year-old man with human immunodeficiency virus (HIV)/
acquired immunodeficiency syndrome (
AIDS) who developed multiple small-vessel
strokes during the immune reconstitution phase. The patient had been diagnosed with HIV/
AIDS with a low CD4 count and high viral load and started combinational antiretroviral
therapy (cART) with
raltegravir,
emtricitabine, and
tenofovir alafenamide fumarate seven months before the admission. He was admitted to our hospital with complaints of mild
dysarthria and left-sided
hemiparesis, but lacking consciousness/cognitive disturbances. Diffusion-weighted images (DWI) revealed multiple areas of hyperintensity in the anterior circulation system of the brain. Because we identified decreased activity of
protein S through extensive examinations, we treated him initially with
intravenous infusion of
heparin sodium and
aspirin; however, DWI detected multiple progressive small-vessel
strokes after that. We considered that the immune reconstitution accounted for the small-vessel vasculopathy/
vasculitis, leading to
ischemic stroke. Therefore, we initiated
oral administration of
prednisolone, which successfully prevented
stroke recurrence. This report describes a case of multiple small-vessel
strokes following cART for
AIDS during the immune reconstitution phase, effectively treated with
steroids, which may often go undiagnosed due to their relatively mild symptoms.