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Human immunodeficiency virus—associated cytomegalovirus infection with multiple small vessel cerebral infarcts in the setting of early immune reconstitution

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Abstract

Cytomegalovirus (CMV) infection is an important cause of neurologic disease in the context of advanced human immunodeficiency virus (HIV) infection and is recognized as a cause of immune reconstitution inflammatory syndrome (IRIS) after initiation of highly active antiretroviral therapy (HAART). Central nervous system vasculitis secondary to CMV has only rarely been described in the context of HIV, despite the established ability of CMV to infect microvascular endothelial cells in the brain. However, we report a case that demonstrates the association between CMV and multiple small vessel cerebral infarct lesions after initiation of HAART.

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References

  • Anduze-Faris BM, Fillet AM, Gozlan J, et al. (2000). Induction and maintenance therapy of cytomegalovirus central nervous system infection in HIV-infected patients. AIDS 14: 517–524.

    Article  CAS  PubMed  Google Scholar 

  • Arribas JR, Storch GA, Clifford DB, Tselis AC (1996). Cytomegalovirus encephalitis. Ann Intern Med 125: 577–587.

    CAS  PubMed  Google Scholar 

  • Berman SM, Kim RC (1994). The development of cytomegalovirus encephalitis in AIDS patients receiving ganciclovir. Am J Med 96: 415–419.

    Article  CAS  PubMed  Google Scholar 

  • Bonkowsky JL, Christenson JC, Nixon GW, Pavia AT (2002). Cerebral aneurysms in a child with acquired immune deficiency syndrome during rapid immune reconstitution. J Child Neurol 17: 457–460.

    Article  PubMed  Google Scholar 

  • Crowe SM, Carlin JB, Stewart KI, Lucas CR, Hoy JF (1991). Predictive value of CD4 lymphocyte numbers for the development of opportunistic infections and malignancies in HIV-infected persons. J Acquir Immune Defic Syndr 4: 770–776.

    CAS  PubMed  Google Scholar 

  • Dobbs MR, Berger JR (2009). Stroke in HIV infection and AIDS. Expert Rev Cardiovasc Ther 7: 1263–1271.

    Article  PubMed  Google Scholar 

  • Duna GF, Calabrese LH (1995). Limitations of invasive modalities in the diagnosis of primary angiitis of the central nervous system. J Rheumatol 22: 662–667.

    CAS  PubMed  Google Scholar 

  • Fish KN, Soderberg-Naucler C, Mills LK, Stenglein S, Nelson JA (1998). Human cytomegalovirus persistently infects aortic endothelial cells. J Virol 72: 5661–5668.

    CAS  PubMed  Google Scholar 

  • French MA (2009). HIV/AIDS: immune reconstitution inflammatory syndrome: a reappraisal. Clin Infect Dis 48: 101–107.

    Article  PubMed  Google Scholar 

  • Gilden DH, Kleinschmidt-DeMasters BK, Wellish M, Hedley-Whyte ET, Rentier B, Mahalingam R (1996). Varicella zoster virus, a cause of waxing and waning vasculitis: the New England Journal of Medicine case 5-1995 revisited. Neurology 47: 1441–1446.

    CAS  PubMed  Google Scholar 

  • Kieburtz KD, Eskin TA, Ketonen L, Tuite MJ (1993). Opportunistic cerebral vasculopathy and stroke in patients with the acquired immunodeficiency syndrome. Arch Neurol 50: 430–432.

    CAS  PubMed  Google Scholar 

  • Klatt EC, Shibata D (1988). Cytomegalovirus infection in the acquired immunodeficiency syndrome. Clinical and autopsy findings. Arch Pathol Lab Med 112: 540–544.

    CAS  PubMed  Google Scholar 

  • Koeppen AH, Lansing LS, Peng SK, Smith RS (1981). Central nervous system vasculitis in cytomegalovirus infection. J Neurol Sci 51: 395–410.

    Article  CAS  PubMed  Google Scholar 

  • Kofteridis DP, Repa A, Anastasopoulos T, et al. (2007). A case of human immunodeficiency virus infection disclosed by cytomegalovirus encephalitis. Int J Infect Dis 11: 373–375.

    Article  CAS  PubMed  Google Scholar 

  • Kossorotoff M, Touze E, Godon-Hardy S, et al. (2006). Cerebral vasculopathy with aneurysm formation in HIV-infected young adults. Neurology 66: 1121–1122.

    Article  CAS  PubMed  Google Scholar 

  • Melica G, Brugieres P, Lascaux AS, Levy Y, Lelievre JD (2009). Primary vasculitis of the central nervous system in patients infected with HIV-1 in the HAART era. J Med Virol 81: 578–581.

    Article  PubMed  Google Scholar 

  • Morgello S, Cho ES, Nielsen S, Devinsky O, Petito CK (1987). Cytomegalovirus encephalitis in patients with acquired immunodeficiency syndrome: an autopsy study of 30 cases and a review of the literature. Hum Pathol 18: 289–297.

    Article  CAS  PubMed  Google Scholar 

  • Nagel MA, Cohrs RJ, Mahalingam R, et al. (2008). The varicella zoster virus vasculopathies: clinical, CSF, imaging, and virologic features. Neurology 70: 853–860.

    Article  CAS  PubMed  Google Scholar 

  • Newsome SD, Nath A (2009). Varicella-zoster virus vasculopathy and central nervous system immune reconstitution inflammatory syndrome with human immunodeficiency virus infection treated with steroids. J NeuroVirol 15: 1–4.

    Article  Google Scholar 

  • Patel AK, Patel KK, Shah SD, Desai J (2006). Immune reconstitution syndrome presenting with cerebral varicella zoster vasculitis in HIV-1-infected patient: a case report. J Int Assoc Physicians AIDS Care 5: 157–160.

    Article  Google Scholar 

  • Ridker PM, Hennekens CH, Stampfer MJ, Wang F (1998). Prospective study of herpes simplex virus, cytomegalovirus, and the risk of future myocardial infarction and stroke. Circulation 98: 2796–2799.

    CAS  PubMed  Google Scholar 

  • Shelburne SA III, Hamill RJ, Rodriguez-Barradas MC, et al. (2002). Immune reconstitution inflammatory syndrome: emergence of a unique syndrome during highly active antiretroviral therapy. Medicine (Baltimore) 81: 213–227.

    Article  Google Scholar 

  • Sinzger C, Grefte A, Plachter B, Gouw AS, The TH, Jahn G (1995). Fibroblasts, epithelial cells, endothelial cells and smooth muscle cells are major targets of human cytomegalovirus infection in lung and gastrointestinal tissues. J Gen Virol 76 (Pt 4): 741–750.

    Article  CAS  PubMed  Google Scholar 

  • Sklar PA, Agyemang AF, Monastra R, et al. (2004). Fiveyear follow-up of a cohort of profoundly immunosuppressed patients discontinuing therapy for cytomegalovirus retinitis. AIDS 18: 567–569.

    Article  PubMed  Google Scholar 

  • Tunkel AR, Glaser CA, Bloch KC, et al. (2008). The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 47: 303–327.

    Article  CAS  PubMed  Google Scholar 

  • Waldman WJ, Knight DA, Huang EH, Sedmak DD (1995). Bidirectional transmission of infectious cytomegalovirus between monocytes and vascular endothelial cells: an in vitro model. J Infect Dis 171: 263–272.

    CAS  PubMed  Google Scholar 

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Correspondence to Albert M. Anderson.

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Anderson, A.M., Fountain, J.A., Green, S.B. et al. Human immunodeficiency virus—associated cytomegalovirus infection with multiple small vessel cerebral infarcts in the setting of early immune reconstitution. Journal of NeuroVirology 16, 179–184 (2010). https://doi.org/10.3109/13550281003735717

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  • DOI: https://doi.org/10.3109/13550281003735717

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