9. Congenital Lymphocytic Choriomeningitis Virus: A Neuropathological Study

Abstract

Lymphocytic choriomeningitis virus (LCMV) carried and secreted by mice, infects great numbers of people. LCMV infection acquired during childhood or adulthood is usually moderately symptomatic with a full recovery. When the infection occurs prenatally, it results in a wide spectrum of severe brain lesions described mainly on imaging. Neuropathological data have never been reported.We present 2 fetuses with a prenatal diagnosis of microcephaly with ventriculomegaly, abnormal gyration, and ponto-cerebellar hypoplasia in one case. Parents elected to terminate the pregnancy. A complete autopsy demonstrated no dysmorphic features, no visceral or skeletal malformation. Histological examination of viscera did not show any significant lesion.Neuropathological examination confirmed microcephaly and ventriculomegaly with a thick yellowish band surrounding the ventricles. Identical histological lesions were observed in both cases associating a polymicrogyria and a diffuse necrosis of parenchyma with massive calcifications all around the ventricles. The most characteristic feature was the unusual aspect of necrosis, distinct from that observed in other infections, characterized by a finely granular appearance looking like sand. Small lymphocytic infiltrates were observed in the leptomeninges and in the choroid but not in the retina. The congenital LCMV infection was confirmed by serologic testing.This study confirms the strong neurotropism of LCMV and demonstrates that prenatal infection has some particular features such as absent systemic signs, and distinct appearance of the necrosis that allow to distinguish it from other congenital infections and other non infectious conditions.