An HIV patient with West Nile encephalitis and Amphiphysin antibodies - More on "West Nile infection triggering autoimmune encephalitis: Pathophysiological and therapeutic implications" by Moutsopoulos et al.

We have encountered a patient with HIV who developed rapid worsening altered mental status positive for both acute West Nile encephalitis and amphiphysin antibodies. Upon literature review, we read Dr. Moutsopoulos's paper from your journal with great interest (Karagianni et al., 2019 [1]). While an autoimmune encephalitis following West Nile encephalitis is not novel, there are several interesting features in a patient we have encountered. Firstly, amphiphysin antibodies coexisting with West Nile encephalitis has not been described before. Second, the fact that the clinical course is monophasic, not biphasic, may lead to the suggestion that autoimmune encephalitis triggered by, or coexisting with, West Nile encephalitis may be grossly underrecognized. Third, our patient was HIV positive, but not grossly immunocompromised, which may have played a factor in the autoimmune status.

Associations between weight change, knee subcutaneous fat and cartilage thickness in overweight and obese individuals: 4-Year data from the osteoarthritis initiative.

OBJECTIVE: To assess (i) the impact of changes in body weight on changes in joint-adjacent subcutaneous fat (SCF) and cartilage thickness over 4 years and (ii) the relation between changes in joint-adjacent SCF and knee cartilage thickness. DESIGN: Individuals from the Osteoarthritis Initiative (total=399) with > 10% weight gain (n=100) and > 10% weight loss (n=100) over 4 years were compared to a matched control cohort with less than 3% change in weight (n=199). 3.0T Magnetic Resonance Imaging (MRI) of the right knee was performed at baseline and after 4 years to quantify joint-adjacent SCF and cartilage thickness. Linear regression models were used to evaluate the associations between the (i) weight change group and 4-year changes in both knee SCF and cartilage thickness, and (ii) 4-year changes in knee SCF and in cartilage thickness. Analyses were adjusted for age, sex, baseline body mass index (BMI), tibial diameter (and weight change group in analysis (ii)). RESULTS: Individuals who lost weight over 4-years had significantly less joint-adjacent SCF (beta range, medial/lateral joint sides: 2.2-4.2 mm, p < 0.001) than controls; individuals who gained weight had significantly greater joint-adjacent SCF than controls (beta range: -1.4 to -3.9 mm, p < 0.001). No statistically significant associations were found between weight change and cartilage thickness change. However, increases in joint-adjacent SCF over 4 years were significantly associated with decreases in cartilage thickness (p = 0.04). CONCLUSIONS: Weight change was associated with joint-adjacent SCF, but not with change in cartilage thickness. However, 4-year increases in joint-adjacent SCF were associated with decreases in cartilage thickness independent of baseline BMI and weight change group.