Recurrent aseptic meningitis associated with type 1 human immunodeficiency virus infection: Case report

• Autor(a) principal: Magalhães, Luísa
• Data de Publicação: 2008
• Outros Autores: Carvalho, Luísa, Paiva, Paulo, Vasconcelos, Carlos
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: https://revista.spmi.pt/index.php/rpmi/article/view/1458
• topic: infecção VIH; meningite asséptica; carga vírica; HIV-1 infection; aseptic meningitis; viral load

Mononuclear meningitis are common during the course of type 1 human immunodeficiency virus (HIV-1) infection, opportunistic agents and tuberculosis being the most usual causes. Aseptic meningitis occurs during the acute retroviral syndrome, but is rare in the chronic stage. The authors present a 44 year-old female, with HIV-1 infection diagnosed in 1994, CD4 T lymphocytes below 200/µL and an immunological response to anti-retroviral therapy. She had a hospital admission for aseptic meningitis in 2000 and recovered without treatment. In 2005 she was admitted with fever and headaches. Her cerebrospinal fluid (CSF) had 152 leucocytes/µL (97% mononuclear), proteins 2.32 g/L and glucose 0.39 g/L. Microbiologic and serologic exams were negative for Mycobacteriae, Herpesvirus, Enterovirus, Cryptococcus, Borrelia and Treponema palidum. She had CD4 T lymphocytes 590/µL and her viral load was 9764 copies/mL in serum and 9998 copies/mL in CSF. She recovered again with no treatment. A cerebral MRI showed multiple sub-cortical enhanced signal foci in the temporal and frontal lobes, which had been present since 2000, asymptomatic and with no defined aetiology. Neurological manifestations in the acute HIV-1 infection correlate with viral load in CSF, but this is unknown for the chronic stage. Association between these manifestations and elevated viral load in CSF could represent a therapeutic escape with worse neurological prognosis. Direct HIV-1 infection should be included in the differential diagnosis of mononuclear meningitides in these patients, in which case, the therapeutic strategy should consider drugs with better central nervous system (CNS) penetration.