RESUMO
BACKGROUND: A contributing factor in triggering autoimmune phenomena is pathogen infections. Here we describe a case that expands the spectrum of infection-associated autoimmune encephalitis and discuss plausible pathogenetic mechanisms. DESIGN: Case report and in silico analysis. RESULTS: A patient with West Nile Virus infection developed autoimmune encephalitis with positive anti-glycine receptor antibodies. Combination therapy with corticosteroids and intravenous immunoglobulin resulted in the resolution of encephalitis signs and symptoms. An in silico analysis unveiled certain sequence similarities between viral antigens and receptor sequence fragments suggesting a molecular mimicry autoimmunization process. CONCLUSIONS: Our case indicates that West Nile Virus infections can trigger autoimmune encephalitis. Our finding expands the spectrum of autoimmune conditions that can develop following an infection. Whether the autoimmunization process is due to molecular mimicry or due to the expansion of natural autoantibody clones merits further investigation.
Assuntos
Encefalite/etiologia , Doença de Hashimoto/etiologia , Imunoglobulinas Intravenosas/farmacologia , Febre do Nilo Ocidental/complicações , Idoso de 80 Anos ou mais , Sequência de Aminoácidos , Anti-Inflamatórios/uso terapêutico , Encefalite/patologia , Doença de Hashimoto/patologia , Humanos , Masculino , Metilprednisolona/uso terapêutico , Proteínas Virais/genética , Proteínas Virais/metabolismo , Vírus do Nilo Ocidental/genética , Vírus do Nilo Ocidental/isolamento & purificaçãoRESUMO
BACKGROUND: Cryoglobulins are associated with chronic infections. OBJECTIVE: To investigate the prevalence of mixed cryoglobulinemia in patients with HIV-1 infection, the clinical spectrum of cryoglobulinemia in these patients, and the possible role of HIV-1 in cryoglobulin formation. DESIGN: Prospective cohort study. SETTING: Laiko Hospital, Athens, Greece. PATIENTS: 89 patients with HIV-1 infection. MEASUREMENTS: Serum and cryoglobulins were evaluated for antibodies to HIV and hepatitis C virus (HCV), HIV-1, and HCV viral load. RESULTS: Mixed cryoglobulins were detected in 24 patients with HIV-1 infection (27% [95% CI, 18% to 36%]). The HIV-1 viral load was higher in cryoglobulin-positive patients (median, 38.25 x 10(3) copies/mL [25th, 75th percentiles: 13.8 x 10(3) copies/mL, 78.55 x 10(3) copies/mL]) than in cryoglobulin-negative patients (median, 5.3 x 10(3) copies/mL [25th, 75th percentiles: 0.7 x 10(3) copies/mL, 27.2 x 10(3) copies/mL]) (P = 0.001). Antibodies to HIV were detected in all cryoprecipitates, and HIV-1 RNA sequences were identified in 22 of the 23 cryoprecipitates examined. Nine cryoglobulin-positive patients (38% [CI, 19% to 54%]) had clinical manifestations compatible with cryoglobulinemia. CONCLUSIONS: Mixed cryoglobulinemia is common in patients with HIV-1 infection.
