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

Abstract

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.