Related Experiment Videos
Multifocal multinucleated giant cell myelitis in an AIDS patient
1Department of Medical Neurosciences, Créteil Faculty of Medicine, University Paris-Val de Marne, France.
Neuropathology and Applied Neurobiology
|April 1, 1991
Summary
This case study highlights HIV-related spinal cord inflammation causing myelopathy in an AIDS patient. Neuropathology revealed multifocal inflammatory changes restricted to the spinal cord, mimicking giant cell encephalitis.
Area of Science:
- Neurology
- Immunology
- Pathology
Background:
- A 19-year-old human immunodeficiency virus (HIV)-positive male with a history of cerebral toxoplasmosis presented with progressive lower limb weakness and urinary retention.
- Intravenous drug use was a significant risk factor in this patient's medical history.
Observation:
- Neurological examination revealed flaccid paraparesis and abnormal reflexes, with normal sensory examination and myelography.
- Cerebrospinal fluid analysis showed elevated protein levels and mild pleocytosis.
- The patient's condition deteriorated, leading to death from septic peritonitis one month after admission.
Findings:
- Neuropathological examination identified chronic toxoplasmosis lesions in the brain and disseminated small necrotic foci with myelin loss, microglial proliferation, macrophages, and multinucleated giant cells (MGC) throughout the spinal cord.
- Immunohistochemistry confirmed the presence of HIV antigens (p24 and p17) within macrophages, MGC, and microglial cells in the spinal cord lesions.
- These spinal cord lesions were consistent with multifocal giant cell encephalitis, despite the brain being spared.
Implications:
- This case demonstrates that HIV-related multifocal inflammatory changes can be predominantly or exclusively localized to the spinal cord.
- Such spinal cord-restricted inflammation can manifest as a significant myelopathy in patients with acquired immunodeficiency syndrome (AIDS).
- The findings underscore the importance of considering HIV-associated myelopathy in the differential diagnosis of neurological deficits in AIDS patients, even when brain imaging is normal.