Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 26, 2024; 12(12): 2065-2073
Published online Apr 26, 2024. doi: 10.12998/wjcc.v12.i12.2065
Human immunodeficiency virus-associated dementia complex with positive 14-3-3 protein in cerebrospinal fluid: A case report
Yun-Sen He, Xiao-Hong Qin, Min Feng, Qin-Jiang Huang, Meng-Jun Zhang, Li-Li Guo, Ming-Bin Bao, Ye Tao, Hong-Yuan Dai, Bo Wu
Yun-Sen He, Department of Neurosurgery, Sichuan Lansheng Brain Hospital & Shanghai Lansheng Brain Hospital Investment Co., Ltd., Chengdu 610036, Sichuan Province, China
Xiao-Hong Qin, Meng-Jun Zhang, Department of Psychiatry, Sichuan Provincial Center for Mental Health, Chengdu 610072, Sichuan Province, China
Min Feng, Department of Geriatrics, Municipal People’s Hospital in Luzhou, Luzhou 646000, Sichuan Province, China
Qin-Jiang Huang, Department of Neurosurgery, Wenjiang District People’s Hospital of Chengdu, Chengdu 611100, Sichuan Province, China
Li-Li Guo, Ming-Bin Bao, Ye Tao, Bo Wu, Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China Chengdu, Chengdu 610072, Sichuan Province, China
Hong-Yuan Dai, Department of Neurology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 610072, Sichuan Province, China
Co-first authors: Yun-Sen He and Xiao-Hong Qin.
Co-corresponding authors: Hong-Yuan Dai and Bo Wu.
Author contributions: Min F contributed to investigation, writing – original draft, review and editing; Huang QJ, Zhang MJ, Bao MB, Tao Y, Wu B, and Dai HY contributed to writing – review and editing; He YS, Qin XH, Min F, Huang QJ, Zhang MJ, Bao MB, Tao Y, and Wu B contributed to data curation; He YS, Qin XH, Min F, and Wu B contributed to methodology; He YS, Qin XH, Huang QJ, Zhang MJ, Bao MB, Tao Y, and Dai HY contributed to the resources; Tao Y contributed to funding acquisition; Dai HY contributed to conceptualization. He YS and Qin XH contributed equally to writing the original draft and to formal analysis, and merit co-first authorship. Dai HY and Wu B have each made distinct contributions to this case report, encompassing clinical treatment and the writing of the case report, respectively, and merit co-corresponding authorship; Dai HY was involved in the clinical treatment and the extended follow-up of this case, as well as verifying the authenticity of clinical data and patient outpatient consultations; Wu B participated in the search for relevant literature, guided the writing of this case report, and was involved in editing, proofreading, and submitting the manuscript. All authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong-Yuan Dai, MD, Chief Physician, Doctor, Department of Neurology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32 West Section 2, First Ring Road, Chengdu 610072, Sichuan Province, China. dhydaihongyuan@sina.com
Received: October 28, 2023
Peer-review started: October 28, 2023
First decision: December 12, 2023
Revised: December 22, 2023
Accepted: March 14, 2024
Article in press: March 14, 2024
Published online: April 26, 2024
Abstract
BACKGROUND

Human immunodeficiency virus (HIV)-associated dementia (HAD) is a subcortical form of dementia characterized by memory deficits and psychomotor slowing. However, HAD often presents with symptoms similar to those of Creutzfeldt-Jakob disease (CJD), particularly in patients with acquired immune deficiency syndrome (AIDS).

CASE SUMMARY

We report the case of a 54-year-old male who exhibited cognitive dysfunction and secondary behavioral changes following HIV infection and suspected prion exposure. The patient was diagnosed with HIV during hospitalization and his cerebrospinal fluid tested positive for 14-3-3 proteins. His electroencephalogram showed a borderline-abnormal periodic triphasic wave pattern. Contrast-enhanced magnetic resonance imaging revealed moderate encephalatrophy and demyelination. Initially, symptomatic treatment and administration of amantadine were pursued for presumed CJD, but the patient’s condition continued to deteriorate. By contrast, the patient’s condition improved following anti-HIV therapy. This individual is also the only patient with this prognosis to have survived over 4 years. Thus, the diagnosis was revised to HAD.

CONCLUSION

In the diagnostic process of rapidly progressive dementia, it is crucial to rule out as many potential causes as possible and to consider an autopsy to diminish diagnostic uncertainty. The 14-3-3 protein should not be regarded as the definitive marker for CJD. Comprehensive laboratory screening for infectious diseases is essential to enhance diagnostic precision, especially in AIDS patients with potential CJD. Ultimately, a trial of diagnostic treatment may be considered when additional testing is not feasible.

Keywords: HIV-associated dementia, Cognitive dysfunction, Creutzfeld-Jakob disease, Rapidly progressive dementia, Case report

Core Tip: In the present case report, we excluded an extremely rare patient with human immunodeficiency virus (HIV) and cerebrospinal fluid 14-3-3 protein-positive. Unlike the previously reported 7 cases, our patient had sustained improvement with anti-HIV therapy and was also the only patient in this entity to survive. Consequently, our report provided a completely different reference for managing rapidly progressive dementia in particular cases.