Abstract Details

Title Acute Aseptic Encephalitis and Reversible Auditory Verbal Agnosia Following Rapid Immune Reconstitution in AIDS: A Case Report

Topic Infections/AIDS/Prion Disease

Presentation(s) P03 - (-)

Poster/Presentation
Number 247

Objective

Background BACKGROUND: Antiretroviral therapy (ART) has reduced opportunistic infections (OI) and improved outcomes in HIV/AIDS patients. However, patients harboring OI who commence ART are also susceptible to an enhanced immunological response called immune reconstitution inflammatory syndrome (IRIS).

Design/Methods DESIGN/METHODS: A 29 year-old woman diagnosed with HIV/AIDS initiated ART on December 2009. CD4 count at nadir was 7/mm3. In December 2012, she developed herpes labialis with a CD4 of 133/mm3. Acyclovir treatment and a new combination ART (Emtricitabine, Tenofovir, Efavirenz) were commenced. In February 2012, she developed headache, nausea/vomiting, seizures and hearing impairment. Admitted on March 2012, she reported an inability to understand spoken speech and claimed all speech was heard as "gibberish."

Results RESULTS: Examination revealed she could hear well, but was unable to understand spoken speech. Reading and writing was preserved but repetition was impaired. Audiometry revealed intact peripheral pure tone hearing but severely impaired word recognition. CD4 count was 1251/mm3 with HIV-RNA copies at 195/mm3. CSF revealed RBC 510/mm3, WBC 5/mm3 (86% lymphocytes), glucose 48 mg/dl, and protein 56 mg/dl. Brain MRI showed multiple lesions in bilateral superior temporal gyri. Brain biopsy revealed neuronal loss, fibrous astrocytosis and T-lymphocyte infiltrates compatible with HIV encephalitis-IRIS (HIVE-IRIS). She received IV methylprednisolone 1g/day for 5 days followed by tapering oral corticosteroids. Clinical improvement with eventual resolution of hearing loss and MRI lesions was seen at 10 weeks.

Conclusions CONCLUSIONS: Although IRIS generally manifests as inflammation against subclinical or persistent infection in HIV patients, this case of IRIS occurred against HIV itself (HIVE-IRIS). Strategic cerebral lesions due to HIVE-IRIS were substrates in this reversible auditory verbal agnosia. In patients with acute HIVE-IRIS with significant neurological deficit without OI, corticosteroid therapy is effective for salvaging neurological function.

Authors/Disclosures
David J. Roh, MD (Columbia University Medical Center) PRESENTER	Dr. Roh has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Portola Pharmaceuticals.
Roshan L. Koul, MD, DM, FRCPCH (Sultan Qaboos University Hospital)	No disclosure on file
Melanie Glenn, MD	No disclosure on file
Susan P. Anzalone, MD (Colorado MS Center, Inc.)	No disclosure on file
	No disclosure on file
Judith Post, MD (Univ of Miami Sch of Med)	No disclosure on file
Ashok Verma, MD, FAAN (University of Miami, Clinical Research Bldg)	Dr. Verma has nothing to disclose.

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