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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2017; 75(12): 897-898
DOI: 10.1590/0004-282X20170163
Images in Neurology

Central nervous system vasculitis in a patient with HIV infection: a diagnostic challenge

Vasculite do sistema nervoso central em um paciente com infecção por HIV: um desafio diagnóstico
Nícolas de O. Amui   *
1   Universidade Federal de São Paulo, Departamento de Neurologia, São Paulo SP, Brasil
,
Roberta G. F. Silva   *
2   Universidade Federal de São Paulo, Divisão de Doenças Infecciosas, São Paulo SP, Brasil
,
Danilo M. C. Costa
3   Universidade Federal de São Paulo, Departamento de Radiologia, São Paulo SP, Brasil
,
Orlando G. P. Barsottini
1   Universidade Federal de São Paulo, Departamento de Neurologia, São Paulo SP, Brasil
,
José Luiz Pedroso
1   Universidade Federal de São Paulo, Departamento de Neurologia, São Paulo SP, Brasil
,
Paulo Roberto Abrão Ferreira
2   Universidade Federal de São Paulo, Divisão de Doenças Infecciosas, São Paulo SP, Brasil
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A 37-year-old woman with HIV infection (CD4: 5 cells/μl) presented with acute dysarthria and right hemiparesis. A brain CT showed nodular hyperdense lesions; MRI depicted cortico-subcortical hyperintense signals ([Figure 1]); MRI and CT angiography disclosed arterial stenosis suggesting vasculitis ([Figure 2]). The cerebrospinal fluid PCR confirmed cytomegalovirus infection. Highly-active antiretroviral therapy was started, but there was worsening of the symptoms, and she died one month later. Brain necropsy confirmed toxoplasmosis.

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Figure 1 Axial brain CT scan without contrast shows calcification in the cerebellar hemispheres (A). Axial T1-weighted brain MRI shows corresponding areas of nodular and irregular enhancement by the gadolinium (B and C). Axial FLAIR brain MRI demonstrates several areas of hyperintense signal in the cerebral cortex and cerebellum (D, E and F).
Zoom Image
Figure 2 Brain MRI angiography shows segmental narrowing of the left middle cerebral artery (arrowhead) with reduction of flow in the opercular segments (arrow) (A). Follow up with brain CT scan angiography shows focal narrowing of the supraclinoid portion of the left internal carotid artery (curved arrow) and reduction of the flow in the left middle cerebral artery (straight arrow) (B).

CNS vasculitis in HIV patients may be caused by several infectious diseases[1], such as CMV, toxoplasmosis, HIV virus, and others[2]. In this report we describe a HIV-infected patient with cerebral vasculitis related to co-infection.


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Conflict of interest:

There is no conflict of interest to declare.

* The first two authors contributed equally to this work.


  • References

  • 1 Hajj-Ali RA, Calabrese LH. Diagnosis and classification of central nervous system vasculitis. J Autoimmun. 2014;48-49:149-52. https://doi.org/10.1016/j.jaut.2014.01.007
  • 2 Finsterer J, Frank M. Parasitoses with central nervous system involvement. Wien Med Wochenschr. 2014;164(19-20):400-4. https://doi.org/10.1007/s10354-014-0307-8

Address for correspondence

Roberta Gunutzmann Ferreira Silva
Divisão de Doenças Infecciosas da UNIFESP; Rua Napoleão de Barros, 715; 04023-900 São Paulo SP
Brasil   

Publication History

Received: 23 January 2017

Accepted: 18 September 2017

Article published online:
01 September 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Hajj-Ali RA, Calabrese LH. Diagnosis and classification of central nervous system vasculitis. J Autoimmun. 2014;48-49:149-52. https://doi.org/10.1016/j.jaut.2014.01.007
  • 2 Finsterer J, Frank M. Parasitoses with central nervous system involvement. Wien Med Wochenschr. 2014;164(19-20):400-4. https://doi.org/10.1007/s10354-014-0307-8

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Zoom Image
Figure 1 Axial brain CT scan without contrast shows calcification in the cerebellar hemispheres (A). Axial T1-weighted brain MRI shows corresponding areas of nodular and irregular enhancement by the gadolinium (B and C). Axial FLAIR brain MRI demonstrates several areas of hyperintense signal in the cerebral cortex and cerebellum (D, E and F).
Zoom Image
Figure 2 Brain MRI angiography shows segmental narrowing of the left middle cerebral artery (arrowhead) with reduction of flow in the opercular segments (arrow) (A). Follow up with brain CT scan angiography shows focal narrowing of the supraclinoid portion of the left internal carotid artery (curved arrow) and reduction of the flow in the left middle cerebral artery (straight arrow) (B).