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HIV-associated CD8+ encephalitis confirmed by cerebrospinal fluid flow cytometry: first case in Colombia
Nicolas Soto-Moreno1,2,3, Nicole Pinzon1,2,3, Natalia Echandia2
1Department of Neurology, Universidad del Rosario, Bogotá, Colombia.
Insights
CD8+ T-cell encephalitis is a rare immune disorder in HIV patients. Diagnosis in this case was confirmed by cerebrospinal fluid flow cytometry, and the patient improved with steroid treatment.
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.
Introduction:
Encephalitis in patients with human immunodeficiency virus (HIV) can be caused by opportunistic infections, immune-mediated processes, or direct viral damage. CD8 + encephalitis is a rare condition. We report the first confirmed case in Colombia, diagnosed by cerebrospinal fluid (CSF) flow cytometry.
Clinical Case:
A 50-year-old man with a history of liver cirrhosis and HIV, who had suspended antiretroviral treatment 1 month prior to admission, presented to the emergency department with a 2-day history of disorientation, bradyphrenia, dysarthria, and headache. Neurological examination revealed agitation, disorientation, language, memory, and abstraction difficulties, as well as ataxia and generalized chorea. The patient's CD4 count was 838 cells. Brain magnetic resonance imaging (MRI) showed bilateral asymmetric leukoencephalopathy, and lumbar puncture revealed lymphocytic pleocytosis. After ruling out other differential diagnoses, flow cytometry confirmed the diagnosis of CD8 + encephalitis by identifying 42 cells (59.73% CD8+). The patient's condition improved following the steroid treatment initiation.
Discussion:
CD8+ T-cell encephalitis is an uncommon immune-mediated disorder in HIV patients, typically occurring when the virus is controlled by antiretroviral therapy. Clinically, it can manifest as global impairment of consciousness, headache and focal symptoms. Diagnosis is typically made via brain biopsy, but imaging and other methods, such as flow cytometry, can be useful. Corticosteroids are the first-line treatment, and prognosis is highly variable.
Conclusion:
CD8-mediated encephalitis is a rare condition that requires a complex diagnosis. We present a case of an HIV patient who responded well to corticosteroid therapy without the need for a brain biopsy, confirmed by flow cytometry.
