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Progressive encephalitis three months after resolution of cutaneous zoster in a patient with AIDS
Abstract:
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 cerebrospinal 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.
Insights
A case of herpes zoster encephalomyelitis in an AIDS patient highlights a fatal neurological condition. This diagnosis requires consideration in immunocompromised individuals with neurological symptoms post-herpes zoster.
Area of Science:
- Neurology
- Virology
- Immunology
Background:
- Acquired immune deficiency syndrome (AIDS) predisposes individuals to opportunistic infections and neurological complications.
- Cutaneous herpes zoster (shingles) can, in rare cases, lead to central nervous system involvement.
Observation:
- A 37-year-old homosexual man with AIDS developed progressive neurological deficits 12 weeks after cutaneous zoster.
- Brain examination revealed necrotic and demyelinative lesions, initially suggestive of progressive multifocal leukoencephalopathy.
- Intranuclear inclusions in brain cells (astrocytes, oligodendrocytes, neurons) were observed.
Findings:
- Herpes zoster encephalomyelitis was diagnosed, confirmed by electron microscopy and molecular analysis.
- The findings suggest a direct viral involvement of the central nervous system by the varicella-zoster virus.
Implications:
- This case underscores the importance of considering zoster-associated encephalomyelitis in the differential diagnosis of encephalopathy in AIDS patients.
- It provides insights into the pathogenesis of viral central nervous system infections in immunocompromised individuals.
- Highlights the need for early recognition and potential antiviral strategies in such cases.