Wiley C A, VanPatten P D, Carpenter P M, Powell H C, Thal L J
Department of Pathology (Neuropathology), University of California, San Diego, La Jolla 92093.
Neurology. 1987 Nov;37(11):1791-4. doi: 10.1212/wnl.37.11.1791.
A 57-year-old diabetic man died of a rapidly ascending necrotizing myelitis. Autopsy results proved that the etiologic agent was herpes simplex virus type 2 (HSV2). The clinical findings, autopsy immunohistopathology, and electron-microscopy suggest that either primary HSV2 infection or reactivation of HSV2 infection within dorsal root ganglia was followed by spread to the spinal cord. Viral infection of the CNS occurred by direct extension and led to death by involvement of the brainstem. Although there is only one previous report of HSV2 myelitis in the literature, our findings suggest that HSV2 might be a more common etiologic agent of necrotizing myelitis. Because CSF cultures are usually negative, viral inclusions are not usually seen, and morphologically identifiable virions are exquisitely rare, previous cases were probably descriptively diagnosed as acute ascending necrotizing myelitis without etiologic identification.
一名57岁的糖尿病男性死于快速进展的坏死性脊髓炎。尸检结果证实病原体为2型单纯疱疹病毒（HSV2）。临床发现、尸检免疫组织病理学及电子显微镜检查表明，要么是原发性HSV2感染，要么是背根神经节内HSV2感染再激活，随后扩散至脊髓。中枢神经系统的病毒感染通过直接蔓延发生，并因脑干受累导致死亡。尽管文献中此前仅有一篇关于HSV2脊髓炎的报道，但我们的发现提示HSV2可能是坏死性脊髓炎更常见的病原体。由于脑脊液培养通常为阴性，通常看不到病毒包涵体，且形态可识别的病毒粒子极为罕见，之前的病例可能在未明确病因的情况下被描述性诊断为急性上升性坏死性脊髓炎。
