Subacute Sclerosing Encephalitis in an Adult with Congenital HIV Infection - Case Report

Abstract

Subacute sclerosing panencephalitis (SSPE) is the result of a chronic infection of the central nervous system caused by a mutated measles virus. We present a case of SSPE in a 19-year-old female with congenital HIV-infection. The patient has been using antiretroviral therapy regularly since she was 4 years old. At the age of 15, she contracted measles of moderate severity. At the age 17, she had the HIV viral load < 20 copies/ml and the CD4 count 420 cells/μl. Three years after measles, bilateral necrotizing retinitis developed, and five months later, myoclonic seizures of the left limbs. Symptoms progressed gradually, with fever, generalised seizures, and lost consciousness. She was hospitalized in department for treatment patient with HIV-infection. Magnetic resonance imaging of the brain revealed massive areas of the altered signal without clear contours in both hemispheres of the brain, which captured the white and grey matter of the fronto-parietal, temporal-occipital lobes. The electroencephalography showed the flashes of slow-wave paroxysmal activity of the brain in the delta range, mainly in the fronto-parietal area. In the cerebral spinal fluid, anti-measles IgG was detected at a titre of 3738,408 U/ml, and in the blood - 9.4 U/ml. A diagnosis of SSPE was established. Supportive, corticosteroids and anticonvulsant treatment were ineffective. Patient died 10 months after the onset of the disease. Therefore, measles at any age in a person with congenital HIV-infection poses a risk of developing SSPE.

Keywords: Immunosuppression; Measles; Neuroretinitis; Panencephalitis; Vaccination.