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CD8+ encephalitis: a severe but treatable HIV-related acute encephalopathy
  1. Angeliki Zarkali1,
  2. Nikos Gorgoraptis1,
  3. Robert Miller2,3,
  4. Laurence John4,
  5. Ashirwad Merve1,
  6. Stefanie Thust1,
  7. Rolf Jager1,5,
  8. Dimitri Kullmann1,6,
  9. Orlando Swayne1,6
  1. 1National Hospital for Neurology and Neurosurgery, London, UK
  2. 2Research Department of Infection and Population Health, University College London, London, UK
  3. 3Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
  4. 4London North West Hospitals, London, UK
  5. 5Neuroradiological Academic Unit, Department of Brain Repair & Rehabilitation, UCL Institute of Neurology, London, UK
  6. 6Institute of Neurology, University College London, London, UK
  1. Correspondence to Dr Angeliki Zarkali, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK; Angeliki.zarkali{at}nhs.net

Abstract

Rapidly progressive encephalopathy in an HIV-positive patient presents a major diagnostic and management challenge. CD8+ encephalitis is a severe but treatable form of HIV-related acute encephalopathy, characterised by diffuse perivascular and intraparenchymal CD8+ lymphocytic infiltration. It can occur in patients who are apparently stable on antiretroviral treatment and probably results from viral escape into the central nervous system. Treatment, including high-dose corticosteroids, can give an excellent neurological outcome, even in people with severe encephalopathy and a very poor initial neurological status. We report a woman with CD8+ encephalitis, with a normal CD4 count and undetectable serum viral load, who made a good recovery despite the severity of her presentation.

  • Confusion
  • CD8+ encephalitis
  • HIV

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Footnotes

  • Twitter Follow Angeliki Zarkali at @Angelika_Za

  • Contributors Clinical care was provided by AZ, NG, RM, LJ, DK and OS. AZ, NG and OS acquired the clinical data and wrote the manuscript and revised the manuscript for critical content. AM interpreted histology and created relevant figure. ST and RJ interpreted imaging and created relevant figure. All authors have reviewed and approved the manuscript.

  • Funding UCLH Biomedical Research Centre.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed. This paper was reviewed by Hadi Manji, London, UK.

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