BK virus associated meningoencephalitis in an AIDS patient treated with HAART

Abstract

A severely immune-suppressed AIDS patient was suspected of suffering from BK virus (BKV) meningoencephalitis, after being studied for common causes of neurological complications of co-infectious origin. Polymerase chain reaction (PCR) and sequence analysis of cerebrospinal fluid and brain samples, confirmed the presence of BKV. His clinical condition improved along with the regression of brain lesions, after modifications on his antiretroviral regime. Five months after discharge, the patient was readmitted because of frequent headaches, and a marked inflammatory reaction was evidenced by a new magnetic resonance imaging (MRI). The symptoms paralleled a rising CD4+ lymphocyte count, and immune reconstitution syndrome was suspected. This is the first non-postmortem report of BKV meningoencephalitis in an AIDS patient, showing clinical and radiographic improvement solely under HAART.

Figure 1

Panel A. Intraoperative brain images in April 2004. An axial T1-weighted image after gadolinium injection (left-hand side) shows lesions in the gray matter of the left temporo-parietal lobe and right occipital lobe (place of biopsy). These images show slight enhancement of the lesions particularly in the meninges and the presence of mass effect. An axial T2-weighted image (center) and a FLAIR image (right-hand side) show better details of the lesions. Panel B. Brain MRI images, 5 months after discharge. Axial T-1 weighted image after gadolinium injection (left-hand side) showed important improvement in gray matter lesions. However, images in T2-weighted (center), and FLAIR (right-hand side) showed presence of new high-signal-intensity lesions in the white matter of the right frontal lobe and left occipital lobe. A widening of the right ventricle compared to the figure in Panel A can be observed. Panel C. Brain MRI images, 7 months after discharge. Axial T-1 weighted image after gadolinium injection (left-hand side) shows normal appearance. Images in T2-weighted (center) and FLAIR (right-hand side) reveal regression of the white matter changes; however discrete widening of the right ventricle is still present.

Figure 2

A) Representative section of the brain biopsy (H&E 40X) shows thickened leptomeninges with an infiltrate composed of lymphocytes and plasmocytes that extended perivascularly. Inset shows an astrocyte with prominent and hyperchromatic nuclei. B) Electrophoresis on 2% agarose gel of BKV PCR products from CSF. Lane 1, Marker 100 bp: Lane 2, negative control of PCR; Lane 3, negative control of extraction; Lane 4, 250 ng DNA; Lane 5, positive control of PCR. C) Electrophoresis on 2% agarose gel of JCV PCR products from brain biopsy. Lane 1, Marker 100 bp; Lane 2, negative control of PCR; Lane 3, negative control of extraction; Lane 4,1000 ng DNA; Lane 5, positive control of PCR.