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Published on: June 2, 2022
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CD8 encephalitis presenting as autoimmune encephalitis in HIV-1 infection
Anna Catrina Wood1, Ruth Parker2, Kieren Allinson3
1School of Clinical Medicine, University of Cambridge, Cambridge, UK acw71@cam.ac.uk.
BMJ Case Reports
|April 23, 2022
Summary
CD8 encephalitis can mimic autoimmune encephalitis clinically and on imaging, leading to misdiagnosis. Early brain biopsy could confirm CD8 encephalitis, though treatment options remain limited.
Area of Science:
- Neurology
- Immunology
- Pathology
Background:
- Autoimmune encephalitis presents with neurological symptoms and can be challenging to diagnose.
- Antibody-negative encephalitis lacks specific serological markers, complicating diagnosis and treatment.
- CD8 encephalitis is a rare T-cell mediated inflammatory brain disease.
Observation:
- A 60-year-old male presented with progressive headache, confusion, and expressive dysphasia.
- The patient experienced declining Glasgow Coma Score and seizures, leading to ICU admission.
- Initial diagnosis was antibody-negative autoimmune encephalitis, treated with immunotherapy.
Findings:
- Postmortem examination revealed CD8 encephalitis as the underlying cause.
- CD8 encephalitis presented with clinical and imaging features similar to autoimmune encephalitis.
- A brain biopsy could have provided a definitive diagnosis during life.
Implications:
- This case highlights the diagnostic challenge posed by CD8 encephalitis.
- It underscores the importance of considering CD8 encephalitis in antibody-negative cases.
- While diagnosis is crucial, current treatment limitations for CD8 encephalitis remain.
