Subacute measles virus encephalitis: a new and fatal opportunistic infection in a patient with AIDS.

Abstract

Encephalitis is a rare complication of measles infection and is of three distinct types: (1) acute encephalitis, (2) subacute sclerosing panencephalitis (SSPE), and (3) subacute measles encephalitis (subacute inclusion body encephalopathy, progressive infectious measles encephalitis) in the immunosuppressed. [1] Acute encephalitis during recovery from measles is probably an autoimmune process and not a productive brain tissue infection. SSPE starts its usually progressive course several years after measles infection in early childhood. [1] Brain histology is characterized by inflammatory infiltrates, glial nodules, degeneration of neurons in the gray matter, neuronophagia, hyperplasia of astro- and microglia, and intranuclear inclusion bodies of Cowdry type A with abundant measles virus antigen. [2] Subacute measles encephalitis occurs in patients with defective cellular immunity from lymphoproliferative illnesses or immunosuppressive therapy. Usually several months after a clinical course of measles, encephalitic signs and symptoms such as seizures, myoclonism, stupor, and coma develop. [1] Histologically, diagnostic features include intranuclear eosinophilic and sometimes intracytoplasmic inclusion bodies in neurons and oligodendrocytes with abundant paramyxovirus nucleocapsids and abundant measles virus antigen. [2] Inflammatory cells are often absent because of immunosuppression. Despite the ubiquity of measles infection and the HIV pandemic, only very few studies on complications of measles virus infection in patients with AIDS have been published. We report here a hemophilic HIV-positive patient who died from subacute measles encephalitis. A short abstract …