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Case Reports
. 2022 Nov 4;12(11):2687.
doi: 10.3390/diagnostics12112687.

CD8 Encephalitis: A Diagnostic Dilemma

Rohan Sharma  1 , Thomas Spradley  2 , Morgan Campbell  3 , Shubham Biyani  4 , Pulkit Singhal  5 , Hisham Elkhider  4 , Krishna Nalleballe  4 , Murat Gokden  6 , Manoj Kumar  7 , Nidhi Kapoor  8
Affiliations
Case Reports

CD8 Encephalitis: A Diagnostic Dilemma

Rohan Sharma et al. Diagnostics (Basel). .

Abstract

CD8+ encephalitis is a subacute encephalopathy associated with HIV infection. Pathophysiology is thought to be auto-reactive CD8+ cells attacking on HIV infected CD4+ cells and 'viral escape' phenomena (replication of CD8+ cells in CSF). We present a case of a 45-year-old man with well controlled HIV who developed CD8 encephalitis following Herpes simplex encephalitis. He had persistent encephalopathy for several weeks with status epilepticus and agitated delirium, and diagnosis remained elusive until a brain biopsy confirmed the diagnosis.

Keywords: CD8 encephalitis; HIV; HSV; encephalitis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Neuroimaging: (a) FLAIR hyperintensity and swelling in bilateral hippocampi and temporal lobes; (b,c) Progressive worsening of FLAIR hyperintensities with associated atrophy at second and third admissions, respectively; (d) T1 hypointensities in bilateral hippocampi with subtle contrast enhancement; (e,f) Progressive worsening of T1 hypointensities without any contrast enhancement, with associated atrophy at second and third admissions, respectively.
Figure 1
Figure 1
Neuroimaging: (a) FLAIR hyperintensity and swelling in bilateral hippocampi and temporal lobes; (b,c) Progressive worsening of FLAIR hyperintensities with associated atrophy at second and third admissions, respectively; (d) T1 hypointensities in bilateral hippocampi with subtle contrast enhancement; (e,f) Progressive worsening of T1 hypointensities without any contrast enhancement, with associated atrophy at second and third admissions, respectively.
Figure 2
Figure 2
Histopathology: (a) An infiltrate of small, round lymphocytes is seen mainly around blood vessels (long arrow), and also scattered within the parenchyma on H&E stain. Prominent microglial proliferation (short arrows) is also present; (b) Essentially complete loss of myelin with no blue staining is seen on LFB/PAS stain; (c) Lymphocytic population is overwhelmingly comprised of CD8-positive T-cells on immunohistochemical staining; (d) CD4 highlights only an occasional CD4-positive T-cell (arrows) with a faint staining of microglial population in the background immunohistochemical staining.
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