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Primary HIV infection presenting with Kaposi sarcoma and limbic encephalitis

  • Dominic Kaddu-Mulindwa
  • Sophie Roth
  • Aline Klees-Rollmann
  • Klaus Fassbender
  • Mathias FousseEmail author
Case Report

Abstract

The development of anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is often associated with neoplasia or infectious diseases as antibodies against neurons or synaptic proteins surface. A 30-year-old male patient was admitted to our department because of neurocognitive symptoms, particularly memory difficulties which had appeared a year prior and since then had been increasing. He had a medical history of smoking and hypertension. On examination, there were no focal neurological deficits. However, neuropsychological tests confirmed a lack of concentration and short-term memory impairment. Brain magnetic resonance imaging (MRI) and electroencephalography (EEG) remained unremarkable. Cerebrospinal fluid (CSF) analysis revealed a low lymphocytic pleocytosis without oligoclonal bands. Serum testing for human immunodeficiency virus (HIV) was positive with 420,000 HIV-1-RNA copies/ml. On a more detailed physical examination, a large number of purple patches were found on the entire body, which a biopsy confirmed to be Kaposi sarcoma (KS). A positive serum and CSF NMDA receptor antibody titer (serum 1:280; CSF 1:8) confirmed the diagnosis of an AIDS-associated anti-NMDA receptor encephalitis; therefore, we treated him with antiretroviral and immunosuppressive therapy. After 12 months, the KS lesions faded and the cognitive deficits improved slightly. Our case highlights that a detailed clinical examination and searching for neoplasia and/or an infection are helpful, though often neglected, tools for detecting an anti-NMDA receptor encephalitis.

Keywords

HIV Anti-NMDA receptor encephalitis Kaposi sarcoma Limbic encephalitis 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethics approval and consent to participate

Not applicable.

Consent for publication

The study participant has given his consent for the publishing of this case in an academic journal.

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Copyright information

© Journal of NeuroVirology, Inc. 2019

Authors and Affiliations

  1. 1.Department of Hematology and OncologySaarland University Medical SchoolHomburg (Saar)Germany
  2. 2.Institute of Medical Microbiology and HygieneSaarland UniversityHomburg (Saar)Germany
  3. 3.Department of NeurologySaarland University Medical SchoolHomburg (Saar)Germany

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