CD8 Encephalitis: A Diagnostic Dilemma

Sharma, Rohan; Spradley, Thomas; Campbell, Morgan; Biyani, Shubham; Singhal, Pulkit; Elkhider, Hisham; Nalleballe, Krishna; Gökden, Murat; Kumar, M.; Kapoor, Nidhi

doi:10.3390/diagnostics12112687

Cited by 2 publications

(3 citation statements)

References 31 publications

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“…Because brain parenchyma lacks resident T-cells, brain CD8+ T-cell infiltration is considered an autoimmune etiology of brain disease [ 15 , 45 ]. Several reports have shown that it occurs in several encephalitic syndromes, including infections such as HIV CD8+ encephalitis [ 14 , 44 , 46 ].…”

Section: Discussionmentioning

confidence: 99%

“…AIE presents a diagnostic challenge as an inflammatory brain disease, with relatively few reported cases in the literature that have undergone brain biopsy or autopsy [ 4 , 12 ]. Recently, a distinct form of CNS immune reconstitution inflammatory syndrome (IRIS) known as ‘CD8 encephalitis’ has been recognized [ 14 , 15 ]. This condition is characterized by the infiltration of CD8+ T cells into the brain in the absence of a high viral burden or typical IRIS presentation.…”

Section: Introductionmentioning

confidence: 99%

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An Autopsy-proven Case-based Review of Autoimmune Encephalitis

Shim,

Kim,

Lim

et al. 2024

Exp Neurobiol

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Autoimmune encephalitis (AIE) is a type of immunoreactive encephalitic disorder and is recognized as the most prevalent noninfectious encephalitis. Nevertheless, the rarity of definitive AIE diagnosis through biopsy or autopsy represents a significant hurdle to understanding and managing the disease. In this article, we present the pathological findings of AIE and review the literature based on a distinct case of AIE presenting as CD8+ T-lymphocyte predominant encephalitis. We describe the clinical progression, diagnostic imaging, laboratory data, and autopsy findings of an 80-year-old deceased male patient. The patient was diagnosed with pulmonary tuberculosis 6 months before death and received appropriate medications. A week before admission to the hospital, the patient manifested symptoms such as a tendency to sleep, decreased appetite, and confusion. Although the patient temporally improved with medication including correction of hyponatremia, the patient progressed rapidly and died in 6 weeks. The brain tissue revealed lymphocytic infiltration in the gray and white matter, leptomeninges, and perivascular infiltration with a predominance of CD8+ T lymphocytes, suggesting a case of AIE. There was no detectable evidence of viral infection or underlying neoplasm. The autopsy revealed that this patient also had Alzheimer’s disease, atherosclerosis, arteriolosclerosis, and aging-related tau astrogliopathy. This report emphasizes the pivotal role of pathological examination in the diagnosis of AIE, especially when serological autoantibody testing is not available or when a patient is suspected of having multiple diseases.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

An Autopsy-proven Case-based Review of Autoimmune Encephalitis

Shim,

Kim,

Lim

et al. 2024

Exp Neurobiol

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“…This encephalitis presents with an acute onset of headache, encephalopathy, seizure, or coma and more commonly affects females. CD8+ encephalitis is a result of an autoimmune attack on the brain via CD8+ T cells, and it is more likely to result in death than HIV encephalitis [ 76 , 77 , 78 ]. In CD8+ encephalitis, perivascular white matter lesions and other diffuse white matter changes with possible cerebral edema are seen on most MRIs [ 78 ].…”

Section: Glutathione In Hiv-associated Dementia (Hiv Encephalitis)mentioning

confidence: 99%

Glutathione in HIV-Associated Neurocognitive Disorders

Erdos,

Masuda,

Venketaraman

2024

CIMB

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A large portion of patients with Human Immunodeficiency Virus (HIV) have neurologic sequelae. Those with better-controlled HIV via antiretroviral therapies generally have less severe neurologic symptoms. However, for many patients, antiretrovirals do not adequately resolve symptoms. Since much of the pathogenesis of HIV/AIDS (Autoimmune Deficiency Syndrome) involves oxidative stress either directly, through viral interaction, or indirectly, through inflammatory mechanisms, we have reviewed relevant trials of glutathione supplementation in each of the HIV-associated neurocognitive diseases and have found disease-specific results. For diseases for which trials have not been completed, predicted responses to glutathione supplementation are made based on relevant mechanisms seen in the literature. It is not sufficient to conclude that all HIV-associated neurocognitive disorders (HAND) will benefit from the antioxidant effects of glutathione supplementation. The potential effects of glutathione supplementation in patients with HAND are likely to differ based on the specific HIV-associated neurocognitive disease.

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CD8 Encephalitis: A Diagnostic Dilemma

Cited by 2 publications

References 31 publications

An Autopsy-proven Case-based Review of Autoimmune Encephalitis

An Autopsy-proven Case-based Review of Autoimmune Encephalitis

Glutathione in HIV-Associated Neurocognitive Disorders

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