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Subacute Sclerosing Encephalitis in an Adult with Congenital HIV Infection - Case Report
Ihor Hryzhak1, Olexandra Pryshlyak2, Victoria Gryb2
1Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine. igryzhak@ifnmu.edu.ua.
Abstract:
Subacute sclerosing panencephalitis (SSPE) is the result of a chronic infection of the central nervous system caused by a mutated measles virus. We present a case of SSPE in a 19-year-old female with congenital HIV-infection. The patient has been using antiretroviral therapy regularly since she was 4 years old. At the age of 15, she contracted measles of moderate severity. At the age 17, she had the HIV viral load < 20 copies/ml and the CD4 count 420 cells/μl. Three years after measles, bilateral necrotizing retinitis developed, and five months later, myoclonic seizures of the left limbs. Symptoms progressed gradually, with fever, generalised seizures, and lost consciousness. She was hospitalized in department for treatment patient with HIV-infection. Magnetic resonance imaging of the brain revealed massive areas of the altered signal without clear contours in both hemispheres of the brain, which captured the white and grey matter of the fronto-parietal, temporal-occipital lobes. The electroencephalography showed the flashes of slow-wave paroxysmal activity of the brain in the delta range, mainly in the fronto-parietal area. In the cerebral spinal fluid, anti-measles IgG was detected at a titre of 3738,408 U/ml, and in the blood - 9.4 U/ml. A diagnosis of SSPE was established. Supportive, corticosteroids and anticonvulsant treatment were ineffective. Patient died 10 months after the onset of the disease. Therefore, measles at any age in a person with congenital HIV-infection poses a risk of developing SSPE.
Insights
Subacute sclerosing panencephalitis (SSPE) can occur in individuals with congenital HIV-infection following measles. This case highlights the risk of SSPE even with effective antiretroviral therapy, emphasizing the need for vigilance.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- Subacute sclerosing panencephalitis (SSPE) is a rare, progressive neurological complication of measles virus infection.
- Congenital HIV infection can alter immune responses, potentially influencing the course of viral infections and their sequelae.
- Antiretroviral therapy (ART) is crucial for managing HIV but may not fully prevent all opportunistic or secondary infections.
Purpose of the Study:
- To report a case of SSPE in a young adult with congenital HIV infection.
- To analyze the clinical presentation, diagnostic findings, and outcome of this rare complication.
- To underscore the potential risk of SSPE following measles in immunocompromised individuals.
Main Methods:
- Case report detailing a 19-year-old female with congenital HIV infection.
- Review of clinical history, including measles exposure and ART management.
- Neurological examination, brain MRI, EEG, and cerebrospinal fluid (CSF) analysis for anti-measles IgG.
- Assessment of treatment response and patient outcome.
Main Results:
- The patient developed SSPE three years after a measles infection, despite well-controlled HIV (viral load < 20 copies/ml, CD4 count 420 cells/μl).
- Clinical manifestations included necrotizing retinitis, myoclonic seizures, fever, and loss of consciousness.
- Brain MRI showed extensive white and grey matter signal abnormalities, EEG revealed slow-wave paroxysmal activity, and CSF showed high anti-measles IgG titers.
- Supportive, corticosteroid, and anticonvulsant treatments were ineffective, and the patient died 10 months after symptom onset.
Conclusions:
- Measles infection at any age poses a risk for developing SSPE in individuals with congenital HIV infection, even with effective ART.
- This case highlights the potential for severe neurological complications despite immune reconstitution in HIV.
- Early recognition and understanding of SSPE pathogenesis in immunocompromised hosts are critical.
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