Fatal Measles Inclusion-Body Encephalitis in Adult with Untreated AIDS, France

Abstract

We report a fatal case of measles inclusion-body encephalitis occurring in a woman from Romania with AIDS. After an extensive but unsuccessful diagnostic evaluation, a pan-pathogen shotgun metagenomic approach revealed a measles virus infection. We identified no mutations previously associated with neurovirulence.

Keywords: France; HIV/AIDS and other retroviruses; MIBE; brain biopsy; measles inclusion-body encephalitis; meningitis/encephalitis; metagenomic; viruses.

Figure 1

Fluid-attenuated inversion recovery images of magnetic resonance examinations of the brain in a 28-year-old woman from Romania with untreated AIDS and measles inclusion-body encephalitis. Images were taken 1 week (A, D, G, J), 2 weeks (B, E, H, K), and 5 weeks (C, F, I, L) after hospital admission, at the same brain levels. The first examination shows focal cortical hyperintensities (yellow arrows) in the left and right frontal cortex. After 2 weeks, these cortical hyperintensities have widened and are spreading to the cingulum and the insula (green arrows). At 5 weeks, cortical hyperintensities involve a larger part of the neocortex, but also spread to the basal ganglia, amygdala (red arrows), and hippocampus (the hippocampus changes may also be induced by status epilepticus) and to the posterior areas of the pons.

Figure 2

Histology and immunohistochemical staining of the cerebral cortex in a 28-year-old woman from Romania with untreated AIDS and measles inclusion-body encephalitis. A) Histology shows moderate increased cellular density and absence of nuclear inclusion bodies. Hematoxylin and eosin stain; original magnification ×100. B) Immunohistochemical staining microglial activation with high CD163 immunoreactivity Anti-human CD163 monoclonal antibody; original magnification ×100 and (inset) ×400.