Varicella‐zoster virus encephalomyelitis with a prominent demyelinating component

The histopathologic presentation of varicella‐zoster virus (VZV) infection of the central nervous system is varied and is not well understood. Here we report a case of VZV encephalomyelitis with prominent demyelinating pathology in a patient with a history of follicular lymphoma treated with allogen...

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Published inNeuropathology Vol. 35; no. 6; pp. 587 - 591
Main Authors Berth, Sarah, Carbunar, Olimpia, Yang, Ning Sarah, Fredericks, Brian, Lipton, Howard L., Valyi‐Nagy, Tibor
Format Journal Article
LanguageEnglish
Published Australia Wiley Subscription Services, Inc 01.12.2015
Subjects
Chicken pox
Demyelinating Diseases - immunology
Demyelinating Diseases - pathology
Demyelinating Diseases - virology
demyelination
Encephalitis, Varicella Zoster - immunology
Encephalitis, Varicella Zoster - pathology
encephalomyelitis
Fatal Outcome
histopathology
Humans
Immunocompromised Host
Lymphoma, Follicular - surgery
Male
Middle Aged
Pain management
Spinal cord
Stem Cell Transplantation - adverse effects
Vaccines
Varicella-zoster virus
encephalomyelitis
histopathology
varicella-zoster virus
demyelination
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Summary:The histopathologic presentation of varicella‐zoster virus (VZV) infection of the central nervous system is varied and is not well understood. Here we report a case of VZV encephalomyelitis with prominent demyelinating pathology in a patient with a history of follicular lymphoma treated with allogeneic stem cell transplantation. The patient presented with waxing and waning bilateral limb weakness and mental status changes. MRI showed leptomeningeal, peripheral spinal cord and periventricular cerebral white matter lesions in the brain, and polymerase chain reaction on cerebrospinal fluid detected VZV DNA. The patient expired from developing atrial fibrillation that rapidly progressed to ventricular fibrillation 10 days after admission to our hospital. Autopsy revealed macrophage‐rich areas of demyelination in the spinal cord and cerebrum with relative preservation of axons associated with inclusion bodies and positive immunostaining for VZV. This case represents a rare example of VZV encephalomyelitis presenting with a predominantly demyelinating, “multiple sclerosis‐like” pathology. The clinical and histopathologic findings and relevant literature are presented and discussed.
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ISSN:0919-6544
1440-1789
DOI:10.1111/neup.12224