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Progressive encephalitis three months after resolution of cutaneous zoster a patient with AIDS
Author(s) -
Ryder John W.,
Croen Kenneth,
KleinschmidtDemasters B. K.,
Ostrove Jeffrey M.,
Straus Stephen E.,
Cohn David L.
Publication year - 1986
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.410190212
Subject(s) - pathology , progressive multifocal leukoencephalopathy , medicine , brain biopsy , leukoencephalopathy , encephalomyelitis , pathogenesis , encephalitis , encephalopathy , differential diagnosis , immunology , biopsy , multiple sclerosis , virus , disease
A 37‐year‐old homosexual man with the acquired immune deficiency syndrome (AIDS) developed progressive, ultimately fatal, neurological deficits 12 weeks after a course of cutaneous zoster. Premortem radiological procedures and cerebrospnal fluid analyses were nondiagnostic. At postmortem examination, several opportunistic infections associated with AIDS were recognized. Throughout the brain, necrotic and demyelinative lesions were present, suggestive of progressive multifocal leukoencephalopathy. However, light microscopical examination showed numerous Cowdry type A intranuclear inclusions in astrocytes, oligodendrocytes, and neurons near the periphery of the lesions. Herpes zoster encephalomyelitis was diagnosed and confirmed by electron microscopy, peroxidase–antiperoxidase staining, and by Southern blot analysis of DNA extracted from brain tissue. This case provides insight into the pathogenesis of zoster‐associated encephalomyelitis and suggests another agent to be considered in the differential diagnosis of encephalopathy in patients with AIDS and other disorders of immunological impairment.