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Hui J, Wang J, Wan Z, Cao Q, Dai B, Lou H, Zhu B. Anti-N-methyl-D-aspartate Receptor Encephalitis in People Living with HIV: Case Report and Literature Review. Neurol Ther 2024; 13:907-916. [PMID: 38530605 PMCID: PMC11136928 DOI: 10.1007/s40120-024-00594-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 02/20/2024] [Indexed: 03/28/2024] Open
Abstract
With the increase in the number of cases of autoimmune encephalitis (AE), the cerebrospinal fluid (CSF) of people living with HIV (PLWH) showing abnormal behavior, cognitive impairment or abnormal movements should be actively screened for the antibody panel of AE. Early recognition and treatment can prevent severe seizures or coma and markedly improve the prognosis of patients. The first-line immunotherapy for AE includes intravenous methylprednisolone and immunoglobulin. However, whether long-time immunosuppressive maintenance therapy is needed is debated. For PLWH, immunosuppressive therapy and even steroids could be more challenging. Here, we review and summarize the clinical characteristics often reported cases and report one case from our center to improve the diagnosis and treatment of anti-N-methyl-D-aspartate receptor encephalitis in PLWH.
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Affiliation(s)
- Jiangjin Hui
- Department of Neurology, The People's Hospital of Beilun District, Beilun Branch Hospital of The First Affiliated Hospital, Zhejiang University School of Medicine, Ningbo, 315826, China
| | - Jinhua Wang
- Department of Neurology, The People's Hospital of Beilun District, Beilun Branch Hospital of The First Affiliated Hospital, Zhejiang University School of Medicine, Ningbo, 315826, China
| | - Zhikai Wan
- Department of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Qing Cao
- Department of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Bohao Dai
- Department of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Haiyan Lou
- Radiology Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Biao Zhu
- Department of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China.
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Autoimmune encephalitis: Suspicion in clinical practice and mimics. J Neuroimmunol 2022; 365:577824. [DOI: 10.1016/j.jneuroim.2022.577824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 02/02/2022] [Accepted: 02/07/2022] [Indexed: 11/20/2022]
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Moloney PB, Hutchinson S, Heskin J, Mulcahy F, Langan Y, Conlon NP, Linas BP, Takahashi C, Cervantes-Arslanian AM. Possible N-methyl-D-aspartate receptor antibody-mediated encephalitis in the setting of HIV cerebrospinal fluid escape. J Neurol 2020; 267:1348-1352. [PMID: 31960135 DOI: 10.1007/s00415-019-09693-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 12/20/2019] [Accepted: 12/28/2019] [Indexed: 10/25/2022]
Abstract
Discordant elevations of cerebrospinal fluid (CSF) human immunodeficiency virus (HIV) ribonucleic acid (RNA) in chronically treated patients known as 'CSF escape' may present as acute encephalitis. Infectious encephalitis caused by herpes simplex virus (HSV) and other neurotropic viruses have been identified as potential triggers of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. Autoantibody-mediated encephalitis has been infrequently reported in HIV infected patients and may mimic HIV encephalitis. We report two adults infected with HIV presenting with encephalopathy and seizures. Case 1 had a monophasic encephalopathy with detection of NMDAR antibodies in the context of HIV CSF escape. There was a clinical response to immunotherapy and anti-retroviral therapy adjustment. Case 2 initially presented in non-convulsive status epilepticus associated with HIV CSF escape. He responded to treatment with anti-epileptic drugs and anti-retroviral therapy alteration, but had two further neurological relapses. NMDAR antibodies were detected during the relapses and a clinical response was observed following treatment with immunotherapy. Clinicians should consider autoimmune encephalitis in HIV infected patients presenting with encephalopathy and seizures, particularly in cases with concomitant HIV CSF escape.
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Affiliation(s)
- Patrick B Moloney
- Department of Neurology and Neurophysiology, St. James's Hospital, Dublin, Ireland
| | - Siobhan Hutchinson
- Department of Neurology and Neurophysiology, St. James's Hospital, Dublin, Ireland
| | - Joseph Heskin
- Department of Genitourinary Medicine and Infectious Diseases, St. James's Hospital, Dublin, Ireland
| | - Fiona Mulcahy
- Department of Genitourinary Medicine and Infectious Diseases, St. James's Hospital, Dublin, Ireland
| | - Yvonne Langan
- Department of Neurology and Neurophysiology, St. James's Hospital, Dublin, Ireland
| | - Niall P Conlon
- Department of Immunology, St. James's Hospital, Dublin, Ireland
| | - Benjamin P Linas
- Departments of Neurology, Neurosurgery and Medicine (Infectious Disease), Boston University Medical Center, Boston, MA, USA
| | - Courtney Takahashi
- Departments of Neurology, Neurosurgery and Medicine (Infectious Disease), Boston University Medical Center, Boston, MA, USA
| | - Anna M Cervantes-Arslanian
- Departments of Neurology, Neurosurgery and Medicine (Infectious Disease), Boston University Medical Center, Boston, MA, USA.
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