Patient Case - AIDS Complicated Viral Encephalitis

 

Case 1

 

Case history and clinical manifestations

It is a case of AIDS definitely diagnosed by CDC, a female aged 16 years, who had history of operational blood infusion. She was definitely diagnosed in Oct. 2003 and had symptoms of fever, headache, dizziness, nausea, neck rigidity and unclear consciousness in Dec. 2004. CD4 count was 27 cells /μl.

 

Imaging demonstrations

Fig. 2-8-1 A,                                                                            Fig. 2-8-1 C

Fig. 2-8-1 A,B,C,D  Axial MR imaging demonstrating cortex swelling in bilateral brain in high T1 and high T2 signals, no demonstrated cerebral interface, flaky high T1 and high T2 signals in bilateral pia mater and obvious edema.

 

Diagnosis

AIDS complicated viral encephalitis.

 

Discussion

AIDS complicated herpes viral encephalitis has favorable prognosis by therapies and the early diagnosis is of great importance. Herpes viral encephalitis involves temporal lobe with demonstrations of other viral infections and the herpes virus causes meningocephalitis. For this case, the patient has extensive intracephalic lesions. Generally, patients with AIDS complicated herpes encephalitis have lesions in frontal lobe and temporal lobe with imaging demonstrations of extensive cerebral swelling, no cerebral interface, abnormal signaling in cortex. For this case, the patient has extensive brain lesions, which is similar to acute disseminated myelencephalitis (ADEM) of non-AIDS patients that have virus infected pia mater diseases with similar manifestations. However, ADEM firstly involves pia mater with following involvement of cortex and has different therapeutic procedure. MR imaging should be performed to differentially diagnose and evaluate the two diseases, and case history should also be considered for diagnosis.