Brain Multiple Focal Processes in a HIV Positive Patient – a Case Report

Czech version

Authors: J. Braunová ¹; D. Sedláček ¹; V. Štruncová ¹; A. Kovandová ¹; D. Matoušková ¹; P. Mukenšnabl ²; J. Kastner ³; S. Amiramini ¹
Authors‘ workplace: Infekční klinika LF UK a FN Plzeň, AIDS centrum Plzeň ¹; Šiklův patologicko-anatomický ústav LF UK a FN Plzeň ²; Klinika zobrazovacích metod LF UK a FN Plzeň ³
Published in: Cesk Slov Neurol N 2013; 76/109(3): 358-361
Category: Case Report

Overview

A case report of a 42-year-old HIV positive woman, who from 2002 fulfilled the AIDS-definition criteria, is presented. She was successfully treated with combined antiretroviral therapy (cART) immediately after confirmation of the AIDS diagnosis. She was in a good clinical condition and her immunological status was also promising. During 2009, a slow progression of neurological symptoms was observed, originally simulating the clinical picture of multiple sclerosis (MS). MRI repeatedly showed multiple lesions in the gray and white brain matters and in the oblongata. The performed investigations did not verify MS, no pathogens other than enteroviruses were found in the CSF. Coxsackie B5, as a probable cause of severe encephalitis, was confirmed by the National Reference Laboratory in Prague by phenotype determination methods. As reported in the literature, enteroviruses can cause various forms of encephalititis, including MS-like syndrome, especially in people suffering from HIV infection. This case report is describing probably the first intra-vitam confirmed encephalitis caused by enteroviruses in a HIV-positive person in the Czech Republic.

Key words:
acquired immunodeficiency syndrome – encephalitis – enterovirus infection – Coxsackie viruses

Sources

1. Beneš J, Bartošová D, Beran J et al. Infekční lékařství. Praha: Galén 2009: 117–119.

2. Černý R, Machala L. Neurologické komplikace HIV/AIDS. Praha: Karolinum 2007.

3. Černý R, Kapla J, Machala L. Ložiskové léze CNS u pacientů s HIV infekcí. Cesk Slov Neurol N 2010; 73/106(4): 374–378.

4. Vališ M, Belada D, Taláb R, Hrudková M, Masopust J, Hornychová H et al. Progresivní multifokální leukoencefalopatie jako komplikace léčby lymfomu – kazuistika. Cesk Slov Neurol N 2009; 72/105(2): 159–161.

5. Wispelwey B, Peterson KM. Intracranial suppuration. In: Schlossberg D (ed). Clinical infectious diseases. Cambridge: Cambridge Univesity Press 2008: 531–539.

6. Berger JR, Dominic BF, Nelson P, Nuovo G. Coxsackie B meningoencephalitis in a patient with acquired immunodeficiency syndrome and multiple sclerosis-like illness. J Neurovirol 2009; 15(3): 282–287.

7. Berger JR, Chumley W, Pittman T, Given C, Nuovo G. Persistent Coxsackie B encephalitis: Report of a case and review of the literature. J Neuro Virol 2006; 12(6): 511–516.