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Acute varicella-zoster virus meningo-myelo-radiculitis in an HIV positive patient.
Dubreuil-Lemaire ML; Gray F; Levy Y; Geny C; Ricolfi F; Sobel A; Hop.
November 30, 1993
Int Conf AIDS. 1993 Jun 6-11;9(1):427 (abstract no. PO-B16-1751). Unique

A 30 y. o. HIV positive patient with a cutaneous and G.I.T. Kaposi sarcoma, was treated by chemotherapy associating Adriamycin and Bleomycin. One month after the second course of treatment, he was admitted to hospital because of acute onset of bilateral lower limb weakness and urinary retention. Neurological examination revealed complete flaccid paraplegia and mild weakness in the arms. Deep tendon reflexes in the lower limbs and plantar responses were absent:pinprick sensation was decreased below T5 level. The patient had fever and drowsiness without meningeal symptoms blood CD4 cells count was 290/mm3 CSF contained 210 WBC/mm3 (71% neutrophils, 16% lymphocytes) and an hyperproteinorachia (240 mg/dl). MRI on T1 weighted sequences with contrast infusion showed a swollen cervical and thoracic cord with central hypodensity no sign of compression. Despite treatment for CMV, toxoplasmosis and bacterial infections, status worsened rapidly, and he died 4 days after his admission. Postmortem examination revealed diffuse ventriculitis with Cowdry type A inclusions in the ependymal cells. Extensive necrotic and haemorrhagic changes with marked necrotising vasculitis involved the entire spinal cord and spinal roots. Immunocytochemistry revealed numerous inclusion bodies positives for varicella-zoster virus (VZV) but not for cytomegalovirus (CMV) and herpes simplex virus type 1 and 2 localized in ependymal, subpial glial, endothelial and Schwann cells. Direct VZV infection of the brain in AIDS patients has been shown to cause leukoencephalitis and cerebral non-inflammatory vasculopathies. This report demonstrates that VZV infection of the central nervous system may also account for meningo-myelo radiculitis eventually secondary to ventriculitis as previously described in CMV infection. Moreover VZV may play a role in the pathogenesis of some AIDS-related vasculitides.

*AIDS-Related Opportunistic Infections/COMPLICATIONS *Herpes Zoster/COMPLICATIONS *Meningitis, Viral/COMPLICATIONS *Myelitis/COMPLICATIONS *Radiculitis/COMPLICATIONS