Infect Chemother.  2012 Dec;44(6):540-543. 10.3947/ic.2012.44.6.540.

Encephalitis due to Acute Human Immunodeficiency Virus Infection

• Kim YC
• Park JE
• Kim MH
• Song JE
• Ahn JY
• Oh DH
• Kim JH
• Lee SH
• Pyo JY
• Jo YJ
• Ku NS
• Han SH
• Kim JM
• Choi JY

• KMID: 1806951
• DOI: http://doi.org/10.3947/ic.2012.44.6.540

Abstract

Clinical presentations associated with acute human immunodeficiency virus (HIV) infection are various and nonspecific. Neurologic manifestations may accompany acute HIV infection. Aseptic meningitis has been described in several reports; however, acute encephalitis during acute HIV infection is rare. Some studies have suggested that antiretroviral therapy for treatment of symptomatic acute HIV infection could be beneficial, especially in severe cases. Encephalitis is life-threatening; therefore, early diagnosis and antiretroviral therapy may be needed. We report on a case of encephalitis associated with acute HIV infection. The patient received early antiretroviral therapy and recovered from encephalitis without neurological sequelae.

Keyword

Acute HIV infection; Encephalitis; Antiretroviral therapy

MeSH Terms

Early Diagnosis
Encephalitis
HIV
HIV Infections
Humans
Meningitis, Aseptic
Neurologic Manifestations

Figure

• 

  Figure 1 Brain magnetic resonance imaging (MRI) shows increased T2 signal intensity involving bilateral hippocampi on hospital day 1 (A) and marked improvement on hospital day 15 (B).

• 

  Figure 2 Electroencephalograph shows continuous waxing and waning and periodic left hemispheric sharp waves with intermittent changes in frequency on hospital day 1 (A) and continuous waxing and waning and rhythmic delta activities on hospital day 15 (B).

Reference

1. Kassutto S, Rosenberg ES. Primary HIV type 1 infection. Clin Infect Dis. 2004. 38:1447–1453.

2. Gaines H, von Sydow M, Pehrson PO, Lundbegh P. Clinical picture of primary HIV infection presenting as a glandular-fever-like illness. BMJ. 1988. 297:1363–1368.

3. Daar ES, Little S, Pitt J, Santangelo J, Ho P, Harawa N, Kerndt P, Glorgi JV, Bai J, Gaut P, Richman DD, Mandel S, Nichols S. Los Angeles County Primary HIV Infection Recruitment Network. Diagnosis of primary HIV-1 infection. Los Angeles County Primary HIV Infection Recruitment Network. Ann Intern Med. 2001. 134:25–29.

4. Cooper DA, Gold J, Maclean P, Donovan B, Finlayson R, Barnes TG, Michelmore HM, Brooke P, Penny R. Acute AIDS retrovirus infection. Definition of a clinical illness associated with seroconversion. Lancet. 1985. 1:537–540.

5. Carne CA, Tedder RS, Smith A, Sutherland S, Elkington SG, Daly HM, Preston FE, Craske J. Acute encephalopathy coincident with seroconversion for anti-HTLV-III. Lancet. 1985. 2:1206–1208.

6. Nzwalo H, Añón RP, Àguas MJ. Acute encephalitis as initial presentation of primary HIV infection. BMJ Case Rep. 2012. pii: bcr0320125970.

7. Brenner BG, Roger M, Routy JP, Moisi D, Ntemgwa M, Matte C, Baril JG, Thomas R, Rouleau D, Bruneau J, Leblanc R, Legault M, Tremblay C, Charest H, Wainberg MA. High rates of forward transmission events after acute/early HIV-1 infection. J Infect Dis. 2007. 195:951–959.

8. Wawer MJ, Gray RH, Sewankambo NK, Serwadda D, Li X, Laeyendecker O, Kiwanuka N, Kigozi G, Kiddugavu M, Lutalo T, Nalugoda F, Wabwire-Mangen F, Meehan MP, Quinn TC. Rates of HIV-1 transmission per coital act, by stage of HIV-1 infection, in Rakai, Uganda. J Infect Dis. 2005. 191:1403–1409.

9. Bell SK, Little SJ, Rosenberg ES. Clinical management of acute HIV infection: best practice remains unknown. J Infect Dis. 2010. 202:Suppl 2. S278–S288.

10. Boufassa F, Bachmeyer C, Carré N, Deveau C, Persoz A, Jadand C, Séréni D, Bucquet D. SEROCO Study Group. Influence of neurologic manifestations of primary human immunodeficiency virus infection on disease progression. J Infect Dis. 1995. 171:1190–1195.

11. Letendre S, Marquie-Beck J, Capparelli E, Best B, Clifford D, Collier AC, Gelman BB, McArthur JC, McCutchan JA, Morgello S, Simpson D, Grant I, Ellis RJ. CHARTER Group. Validation of the CNS Penetration-Effectiveness rank for quantifying antiretroviral penetration into the central nervous system. Arch Neurol. 2008. 65:65–70.