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West Nile Virus Central Nervous System Infection in Patients Treated With Rituximab: Implications for Diagnosis and Prognosis, With a Review of Literature.

Morjaria S, Arguello E, Taur Y, Sepkowitz K, Hatzoglou V, Nemade A, Rosenblum M, Cavalcanti MS, Palomba ML, Kaltsas A - Open Forum Infect Dis (2015)

Bottom Line: The spectrum of West Nile virus (WNV) infection continues to be elucidated.Many cases of WNV are asymptomatic; however, in immunocompromised patients, symptoms are more likely to be severe.We describe fatal WNV central nervous system disease in lymphoma patients who received rituximab, blunting the inflammatory response and complicating diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Infectious Disease Service, Department of Medicine.

ABSTRACT
The spectrum of West Nile virus (WNV) infection continues to be elucidated. Many cases of WNV are asymptomatic; however, in immunocompromised patients, symptoms are more likely to be severe. We describe fatal WNV central nervous system disease in lymphoma patients who received rituximab, blunting the inflammatory response and complicating diagnosis.

No MeSH data available.


Related in: MedlinePlus

(A) T-cell infiltration is demonstrated in this immunohistochemical preparation for CD3 (hematoxylin counterstain, 40×). (B) Immunohistochemical preparation for CD79a of a contiguous section to that shown in the previous figure demonstrates complete absence of B cells in the same area (hematoxylin counterstain, 40×).
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OFV136F1: (A) T-cell infiltration is demonstrated in this immunohistochemical preparation for CD3 (hematoxylin counterstain, 40×). (B) Immunohistochemical preparation for CD79a of a contiguous section to that shown in the previous figure demonstrates complete absence of B cells in the same area (hematoxylin counterstain, 40×).

Mentions: Permission was granted for an autopsy limited to only the brain and rostral cervical spinal cord. Gross examination of the brain revealed bilateral softening and hemorrhagic discoloration of the thalami principally involving the dorsomedian regions with additional small foci of necrosis and hemorrhage in the midbrain and basis pontis, a pathologic correlate of brain MRI findings. Histologic and immunohistochemical examination showed these areas to exhibit perivascular and interstitial infiltration by T lymphocytes represented mainly by CD8+/CD4− cytotoxic/suppressor T cells (Figure 1A). Special stains for lymphocytes expressing B-cell markers (CD20, CD79a, PAX 5) failed to identify such cells in the tissue (Figure 1B).Figure 1.


West Nile Virus Central Nervous System Infection in Patients Treated With Rituximab: Implications for Diagnosis and Prognosis, With a Review of Literature.

Morjaria S, Arguello E, Taur Y, Sepkowitz K, Hatzoglou V, Nemade A, Rosenblum M, Cavalcanti MS, Palomba ML, Kaltsas A - Open Forum Infect Dis (2015)

(A) T-cell infiltration is demonstrated in this immunohistochemical preparation for CD3 (hematoxylin counterstain, 40×). (B) Immunohistochemical preparation for CD79a of a contiguous section to that shown in the previous figure demonstrates complete absence of B cells in the same area (hematoxylin counterstain, 40×).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4643542&req=5

OFV136F1: (A) T-cell infiltration is demonstrated in this immunohistochemical preparation for CD3 (hematoxylin counterstain, 40×). (B) Immunohistochemical preparation for CD79a of a contiguous section to that shown in the previous figure demonstrates complete absence of B cells in the same area (hematoxylin counterstain, 40×).
Mentions: Permission was granted for an autopsy limited to only the brain and rostral cervical spinal cord. Gross examination of the brain revealed bilateral softening and hemorrhagic discoloration of the thalami principally involving the dorsomedian regions with additional small foci of necrosis and hemorrhage in the midbrain and basis pontis, a pathologic correlate of brain MRI findings. Histologic and immunohistochemical examination showed these areas to exhibit perivascular and interstitial infiltration by T lymphocytes represented mainly by CD8+/CD4− cytotoxic/suppressor T cells (Figure 1A). Special stains for lymphocytes expressing B-cell markers (CD20, CD79a, PAX 5) failed to identify such cells in the tissue (Figure 1B).Figure 1.

Bottom Line: The spectrum of West Nile virus (WNV) infection continues to be elucidated.Many cases of WNV are asymptomatic; however, in immunocompromised patients, symptoms are more likely to be severe.We describe fatal WNV central nervous system disease in lymphoma patients who received rituximab, blunting the inflammatory response and complicating diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Infectious Disease Service, Department of Medicine.

ABSTRACT
The spectrum of West Nile virus (WNV) infection continues to be elucidated. Many cases of WNV are asymptomatic; however, in immunocompromised patients, symptoms are more likely to be severe. We describe fatal WNV central nervous system disease in lymphoma patients who received rituximab, blunting the inflammatory response and complicating diagnosis.

No MeSH data available.


Related in: MedlinePlus