EACS2023: 1095 Limbic encephalitis following COVID-19 vaccination in an HIV-positive patient A. Inciarte , J.L. Blanco Arevalo , C. Cardozo Hospital Clinic Barcelona, Infectious disease, Barcelona, Spain Title Clinical case title: Limbic encephalitis following COVID-19 vaccination in an HIV-positive patient Clinical case body Text: Introduction: The association between COVID-19 vaccination and limbic encephalitis (LE) still needs to be documented in the medical literature. This case study adds to the limited understanding of potential neurological manifestations post-vaccination. Clinical presentation: A 39-year-old patient with controlled HIV, Cd4 count 680 cells/ml, received their second Pfizer vaccine on July 20. After developing a fever and tonsillitis by August 12, subsequent symptoms like confusion, hallucinations, bradypsychia, anterograde memory loss, and reduced calculation skills required ICU admission. The cerebral scanner was normal. Cerebrospinal fluid (CSF) showed protein levels of 66 mg/dL and 100 nucleated cells, with 81% being neutrophils. PCR tests, including for VVZ and Cryptococcus, yielded negative. Electroencephalogram showcased diffuse encephalopathy with periodic left temporal spikes. After a negative infectious screening, the initial antibiotics and antivirals given to the patient were discontinued, and treatment with dexamethasone began, followed by a gradual dosage reduction of prednisone. An MRI on August 17 spotlighted a left hippocampal hyperintensity, and a right acoustic neuroma. A CSF on August 20 indicated a 61 mg/dL protein, 20 cells (99% lymphocytes), positive oligoclonal bands (OCBs), and IgG with 74.00 mg/L levels. Antionconeuronal antibodies; (Hu, CV2/CRMP5, Ma2, GAD65, NMDAR, GABAbR, LGI1, CASPR2) were negative, culminating in a LE diagnosis. The reported patient exhibits an 8.3% proportion of CD3-CD8+ non-T lymphocytes (NK type) and OCBs, supporting the immunological hypothesis. Outpatient follow-up in October 2021 showcased full recovery. After counseling, the patient received a 3rd and 4th Pfizer vaccine dosing six months after full recovery. Conclusion: A 39-year-old HIV-controlled patient exhibited limbic encephalitis symptoms after the second Pfizer COVID-19 vaccine dose. Diagnostic findings supported an immunological link to the vaccine. After treatment and recovery, the patient safely received additional Pfizer vaccine doses, stressing the intricate nature of post-vaccination neurological responses. Table 1. Lab findings. Date Lab Value Name Value Range August 13CSF Protein 66 mg/dL 30 mg/dl August 13CSF Nucleated Cells 100 cells 10 cells August 13CSF Neutrophils 81% Not provided August 13CSF Lymphocytes 17% Not provided August 13Rapid PCR Results Negative Not provided August 13VVZ (Varicella-Zoster Virus) PCR Negative Not provided August 13Cryptococcus PCR Negative Not provided August 13CSF Antigen for Cryptococcus Negative Not provided August 13PCR Test for Herpes 1, 2, and 6 Undetectable Not provided August 20CSF Protein 61 mg/dL 30 mg/dl August 20CSF Nucleated Cells 20 cells 10 cells August 20CSF Lymphocytes 99% Not provided August 20CSF Oligoclonal Bands (OCBs) IgG Positive Not provided August 20CSF IgG Levels 74.00 mg/L Normal range: 20 - 40 mg/L August 20Viral Load in CSF <50 copies/mL Not provided October 21CD3-CD8+ Lymphocytes (NK type) 8.3% Not provided October 21CD8+ Lymphocyte Count 1994 cells/microliterNormal range: 330 - 920 cells/microliter October 21CD3+ Lymphocyte Count 2997 cells/microliterNormal range: 1000 - 2000 cells/microliter Figure1 MRI Axial/coronal Figure2 Sagital 1 1 1 1 861
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