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.

Automated summary

We encountered a patient with HIV who showed rapid deterioration in mental status and was positive for both acute West Nile encephalitis and amphiphysin antibodies. After reviewing the literature, we found Dr. Moutsopoulos's paper from your journal highly interesting (Karagianni et al., 2019 [1]). Although autoimmune encephalitis following West Nile encephalitis is not uncommon, there are several intriguing aspects in our patient's case. Firstly, the coexistence of amphiphysin antibodies with West Nile encephalitis has not been reported before. Secondly, the monophasic clinical course suggests that autoimmune encephalitis triggered by or coexisting with West Nile encephalitis may be significantly underrecognized. Lastly, our patient was HIV positive but not severely immunocompromised, which may have contributed to the autoimmune status.