HIV-associated CD8+ encephalitis confirmed by cerebrospinal fluid flow cytometry: first case in Colombia

Area of Science:

• Neuroimmunology
• Infectious Diseases
• HIV Medicine

Background:

• Encephalitis in human immunodeficiency virus (HIV) patients has diverse causes, including opportunistic infections, immune processes, and direct viral damage.
• CD8+ T-cell encephalitis is a rare immune-mediated condition in HIV patients, often associated with controlled viral replication.
• This case represents the first confirmed instance of CD8+ T-cell encephalitis in Colombia.

Purpose of the Study:

• To report the first confirmed case of CD8+ T-cell encephalitis in Colombia.
• To highlight the diagnostic utility of cerebrospinal fluid (CSF) flow cytometry in this rare condition.
• To demonstrate the efficacy of corticosteroid treatment in a patient with HIV-associated CD8+ T-cell encephalitis.

Main Methods:

• Case report of a 50-year-old male with a history of HIV and liver cirrhosis.
• Clinical presentation included disorientation, bradyphrenia, dysarthria, ataxia, and chorea.
• Diagnosis was confirmed using CSF flow cytometry, identifying a significant population of CD8+ T-cells, following exclusion of other causes and characteristic MRI findings.

Main Results:

• Cerebrospinal fluid flow cytometry confirmed CD8+ T-cell encephalitis by identifying 59.73% CD8+ cells.
• Brain MRI revealed bilateral asymmetric leukoencephalopathy, and CSF showed lymphocytic pleocytosis.
• The patient experienced clinical improvement after initiation of corticosteroid therapy, avoiding the need for brain biopsy.

Conclusions:

• CD8+ T-cell encephalitis is a rare but significant cause of neurological dysfunction in HIV patients.
• Cerebrospinal fluid flow cytometry is a valuable tool for diagnosing CD8+ T-cell encephalitis, offering an alternative to brain biopsy.
• Corticosteroid therapy can be effective in managing HIV-associated CD8+ T-cell encephalitis, leading to favorable patient outcomes.