Chrétien F, Gray F, Lescs M C, Geny C, Dubreuil-Lemaire M L, Ricolfi F, Baudrimont M, Levy Y, Sobel A, Vinters H V
Départment de Pathologie (Neuropathologie), Hôpital Henri Mondor, Faculté de Médecine de Créteil, Université Paris XII, France.
Acta Neuropathol. 1993;86(6):659-65. doi: 10.1007/BF00294307.
A 30-year-old AIDS patient with no history of cutaneous eruption, presented with rapidly progressive flaccid paraplegia, hypoesthesia, urinary retention, moderate psychomotor slowing and fever (39.8 degrees C), leading to death within 1 week. CD4 count was 290/mm3. Cerebrospinal fluid contained 210 white blood cells and 238 mg/100 ml protein. Neuropathology revealed HIV encephalitis and diffuse ventriculitis with Cowdry type A inclusions in the ependymal cells. Extensive necrotic and hemorrhagic changes with marked recrotizing vasculitis involved the entire spinal cord and spinal roots. Immunocytochemistry revealed numerous inclusion bodies positive for varicella-zoster virus (VZV) and negative for cytomegalovirus (CMV) and herpes simplex virus type 1 and 2, in ependymal cells, subpial glial cells, endothelial cells and Schwann cells. Electron microscopy confirmed herpes virus-like particles. In situ hybridization confirmed VZV genome in leptomeninges, brain, spinal cord and spinal roots. Comparable neuropathological findings and numerous VZV inclusion bodies were also found in the brain, spinal cord, and spinal roots of a 40-year-old AIDS patient who died from a fulminant ascending myeloradiculopathy previously reported as "necrotizing vasculitis of the nervous system". Direct infection of the brain by VZV, in AIDS patients, has been shown to cause leukoencephalitis and cerebral non-inflammatory vasculopathies. Our observations demonstrate that, in AIDS patients, VZV infection of the central nervous system may also be responsible for meningo-myelo-radiculitis possibly secondary to ventriculitis as in CMV infection. The role of VZV in the pathogenesis of some AIDS-related vasculitides seems also very likely.
一名30岁的艾滋病患者，既往无皮疹病史，出现快速进展的弛缓性截瘫、感觉减退、尿潴留、中度精神运动迟缓及发热（39.8℃），1周内死亡。CD4细胞计数为290/mm³。脑脊液中白细胞计数为210个，蛋白含量为238mg/100ml。神经病理学检查显示为HIV脑炎及弥漫性脑室炎，室管膜细胞内可见A 型Cowdry包涵体。广泛的坏死和出血性改变以及显著的坏死性血管炎累及整个脊髓和神经根。免疫细胞化学检查显示，室管膜细胞、软脑膜下神经胶质细胞、内皮细胞及施万细胞内有大量水痘-带状疱疹病毒（VZV）包涵体，巨细胞病毒（CMV）及单纯疱疹病毒1型和2型均为阴性。电子显微镜检查证实有疱疹病毒样颗粒。原位杂交在软脑膜、脑、脊髓及神经根中证实有VZV基因组。在一名40岁因暴发性上升性脊髓神经根病死亡的艾滋病患者的脑、脊髓及神经根中也发现了类似的神经病理学表现及大量VZV包涵体，该患者此前被报道为“神经系统坏死性血管炎”。在艾滋病患者中，VZV直接感染脑部已被证明可引起白质脑炎和脑非炎性血管病变。我们的观察结果表明，在艾滋病患者中，VZV感染中枢神经系统也可能导致脑膜脊髓神经根炎，可能继发于脑室炎，如同CMV感染一样。VZV在某些艾滋病相关血管炎发病机制中的作用似乎也很可能。
