Budka H, Jellinger K, Wolf A, Zazgornik J, Stummvoll H K, Schmidt P, Pinggera W F, Kopsa H
Wien Klin Wochenschr. 1976 Mar 5;88(5):175-9.
The neuropathological features are presented of an autopsy series of 43 renal transplant recipients. Inflammatory CNS lesions were found in 18 cases and were attributable to secondary CNS involvement in bacterial or fungal septicaemia (8 cases) or in localized extraneural infections (5 cases). Mixed bacterial-fungal infection and bacterial-fungal-viral triple infection were seen in one case each. Isolated toxoplasmic granulomas were observed in two cases. No tissue changes typical of CNS viral infections, including cytomegaly, were found except for small glial nodules in the brain stem in 7 cases. Massive intracerebral haemorrhages were seen in 2 cases after haemodialysis; subdural haematoma occurred once. Non-specific changes including brain oedema and diffuse glial poliodystrophy were found in many cases; vascular lesions and purpura occurred only seldom. A meningocerebellar malignant lymphoma, probably of metastatic origin was found in one case. Clinico-pathological correlation was poor in 5 cases; this is considered to be due to immunosuppressive therapy, which may mask either clinical expression of severe CNS lesions or morphological expression of viral encephalitis.
本文呈现了43例肾移植受者尸检系列的神经病理学特征。18例发现有炎性中枢神经系统病变，这些病变归因于细菌或真菌败血症（8例）或局部神经外感染（5例）继发的中枢神经系统受累。各有1例出现混合细菌 - 真菌感染以及细菌 - 真菌 - 病毒三重感染。2例观察到孤立的弓形虫肉芽肿。除7例脑干有小胶质结节外，未发现典型的中枢神经系统病毒感染组织变化，包括细胞肿大。2例在血液透析后出现大量脑出血；硬膜下血肿出现1次。许多病例发现有包括脑水肿和弥漫性胶质营养不良等非特异性变化；血管病变和紫癜很少发生。1例发现可能为转移性起源的脑膜小脑恶性淋巴瘤。5例临床病理相关性较差；这被认为是由于免疫抑制治疗，其可能掩盖严重中枢神经系统病变的临床表现或病毒性脑炎的形态学表现。
