SUBACUTE FOCAL ADENOVIRUS ENCEPHALITIS

Abstract

Subacute adenovirus encephalitis, a hitherto undescribed neuropathologic entity, is described in a 42-year-old patient who had a malignant lymphoma and was vigorously treated with various therapeutic immunosuppressive measures during the terminal five years of his illness. The patient developed altered consciousness and convulsions one month prior to death. Focal necrosis mimicking an old cystic encephalomalacia was noted in the left occipital lobe. Characteristic histopathologic features were 1) gigantic basophilic nuclear inclusions of cortical neurons, 2) extensive subpial mineralization, 3) marked astrogliosis and microgliosis, 4) petechial hemorrhages, and 5) perivascular lymphocytic infiltrates. Electron-microscopy revealed numerous viral particles and crystalline arrays within the nuclear inclusions characteristic of adenovirus. Identification of adenovirus was substantiated by the immunofluorescent method and the presence of 252 capsomeres per virion with negative stain technique. An adenovirus closely related with adenovirus type 32 was isolated from the frozen brain tissue.