title: Relapsing CD8+ encephalitis-looking for a solution.
abstract: CD8+ encephalitis (CD8+E) is an emerging and incompletely understood HIV-associated neurological syndrome, typically presenting as a steroid-responsive subacute encephalopathy with prominent white matter changes in patients with apparently well-controlled HIV infection. Some cases can be associated with the phenomenon of 'viral escape' (disproportionate replication within the cerebrospinal fluid), but the most important pathophysiology of CD8+E is thought to involve an attack on HIV-infected CD4+ lymphocytes by autoreactive CD8+ cells. We report a case of CD8+E where the initial positive response to steroid treatment was followed by several relapses on withdrawal. This led to the use of mycophenolate mofetil (MMF) as a long-term steroid-sparing agent, which is the first time this approach has been reported in the literature. The patient has now been on treatment with MMF for 10 months and it has been possible to taper the steroids down to a minimal maintenance dose without further relapse.
authors.affiliation: Department of Neurology, Salford Royal NHS Foundation Trust, Salford, UK Pennine Acute Hospitals NHS Trust, Manchester, UK.
authors.forename: Sharfaraz
authors.initials: S
authors.lastname: Salam
authors.affiliation: Department of Neurology, Salford Royal NHS Foundation Trust, Salford, UK.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Mihalova
authors.affiliation: Pennine Acute Hospitals NHS Trust, Manchester, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Ustianowski
authors.affiliation: Department of Neurology, Salford Royal NHS Foundation Trust, Salford, UK.
authors.forename: David
authors.initials: D
authors.lastname: McKee
authors.affiliation: Department of Radiology, Salford Royal NHS Foundation Trust, Salford, UK.
authors.forename: Rehka
authors.initials: R
authors.lastname: Siripurapu
mesh_terms: D000328:Adult; D018414:CD8-Positive T-Lymphocytes / Q000187:drug effects*; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D004660:Encephalitis / Q000188:drug therapy* / Q000276:immunology / Q000503:physiopathology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D009173:Mycophenolic Acid / Q000627:therapeutic use*; D011239:Prednisolone / Q000627:therapeutic use*; D012008:Recurrence; D012074:Remission Induction; D016896:Treatment Outcome; D019562:Viral Load / Q000187:drug effects
chemical_list: D007166:Immunosuppressive Agents; D011239:Prednisolone; D009173:Mycophenolic Acid