Abstract Details

Title NMDAR encephalitis associated with HIV "CNS escape"

Topic Autoimmune Neurology

Presentation(s) P2 - Poster Session 2 (5:30 PM-6:30 PM)

Poster/Presentation
Number 15-008

Objective NA

Background Whilst the introduction of cART has drastically reduced the incidence of HIV-related opportunistic infections, there has been increased recognition of immune dysregulation syndromes including IRIS and CD8+ encephalitis. We report a case of NMDAR encephalitis in a patient with known HIV infection possibly triggered by "CNS escape”.

Design/Methods NA

Results

A 49-year-old man with HIV presented with progressive confusion, agitation and poor balance following a convulsive seizure one month previously. At presentation, HIV RNA in serum was 916 copies/ml and CD4 count was 180 cells/µL. (HIV RNA in serum was undetectable 10 months previously). Neurological examination revealed inattention, subtle right-sided motor seizures, and gait ataxia.

CSF analysis revealed mononuclear pleocytosis (160 cells/mm³) and raised protein (122mg/dL). Bacterial, viral (including JCV), fungal and mycobacterial testing was negative. MR imaging of brain showed findings suggestive of meningoencephalitis with notable involvement of the basal ganglia. EEG revealed severe encephalopathy with extreme delta brush pattern. NMDAR antibodies were detected in serum and CSF by indirect immunofluorescence. HIV RNA in CSF was disproportionately raised compared to serum at 42365 copies/ml, suggesting "CNS escape”.

Treatment with steroids and IVIg resulted in marked clinical improvement. His cART was adjusted to increase CSF penetration.

Conclusions Autoimmune encephalitis is an important consideration in patients with HIV presenting with altered mental state and seizures. "CNS escape” as a trigger for humoral autoimmunity is a plausible mechanism, particularly given the well described association between HSV1 and NMDAR antibodies.

Authors/Disclosures
Patrick B. Moloney, MBBS PRESENTER	No disclosure on file
	No disclosure on file
Yvonne Langan	Yvonne Langan has nothing to disclose.
	No disclosure on file
	No disclosure on file
Siobhan Hutchinson, MD (St. James'S Hospital)	Dr. Hutchinson has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Hutchinson has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Teva. Dr. Hutchinson has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Teva.

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