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. 2019 Oct 1;6(10):ofz366.
doi: 10.1093/ofid/ofz366.

HIV-Associated Vacuolar Encephalomyelopathy

Gregory R Madden  1 , Molly E Fleece  1 , Akriti Gupta  2 , M Beatriz S Lopes  2 , Scott K Heysell  1 , Christopher J Arnold  1 , Brian Wispelwey  1
Affiliations

HIV-Associated Vacuolar Encephalomyelopathy

Gregory R Madden et al. Open Forum Infect Dis. .

Abstract

We report a case of human immunodeficiency virus (HIV)-associated vacuolar encephalomyelopathy with progressive central nervous system dysfunction and corresponding vacuolar degeneration of the spinal cord, cranial nerves, and brain, the anatomic extent of which has not previously been described.

Keywords: AIDS; HIV; Vacuolar Myelopathy.

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Figures

Figure 2.
Figure 2.
Representative sections of the brain and spinal cord. The thoracic levels of the spinal cord were the most affected by the vacuolar changes, with extensive involvement of lateral corticospinal tract (A) and portions of the posterior column (A). The vacuolar changes, highlighted by myelin stain (Luxol Fast Blue [LFB]) in (B), were accompanied by an accumulation of macrophages containing myelin (C), as demonstrated by CD68 immunostain. Similar vacuolar changes were present in the brain stem (superior cerebellar peduncle) (D) and the bilateral thalami (E), with macrophages containing myelin debris (LFB) (F). The extension of macrophagic infiltration can be appreciated by CD68 immunostain in this thoracic level of the spinal cord (G), with the entire posterior, lateral, and ventral tracts involved. The optic chiasm and optic tracts showed similar vacuolar changes (H).
Figure 1.
Figure 1.
Compared with previous magnetic resonance imaging of the brain (A) 12 days prior, there were new (B) symmetric, punctate foci of diffusion restriction (circled) within the bilateral posterolateral thalami, with corresponding fluid-attenuated inversion recovery hyperintensity (shown) without associated edema.
See this image and copyright information in PMC

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