We report a case of a 32-year-old female who presented with neck pain followed by weakness of all four limbs for five days. She had neck pain with electric shock like sensation running down the spine on flexing the neck. She developed weakness of all four limbs over few hours. There was no history of preceding fever, headache, seizure or trauma. There was no significant past or family history. She did not have history of high-risk sexual behavior or injection drug use. She was a newly diagnosed case of treatment naive HIV infection with LETM. Patient was started on antiretroviral therapy (ART) with intravenous methylprednisolone pulse therapy (1gm/day) for five days. Patient improved significantly over next few weeks. She was able to walk with minimal support. Patient was discharged to follow up in ART clinic.