Early viral brain invasion in iatrogenic human immunodeficiency virus infection.
We report a 68-year-old man who received an IV inoculation of WBCs for an indium radionuclide scan containing 600 to 700 tissue culture infectious doses of human immunodeficiency virus type 1 (HIV-1) from an HIV-1-infected individual. The recipient immediately received zidovudine, then was switched to dideoxyinosine and interferon-alpha, but died of hepatorenal syndrome and hepatic encephalopathy 15 days later. HIV-1 cultures were positive from the recipient's blood on day 14 but not days 0, 1, and 8. At autopsy, cultures of parietal lobe isolated HIV-1. HIV-1 nucleic acid was present in several brain areas, but not in several other organs, by two independent laboratories using the polymerase chain reaction. The brain showed mild perivascular cuffing and a mild lymphocytic meningitis, but there was no evidence of glial nodules, giant cells, or white matter abnormalities. HIV-1 pg41 viral antigen was seen by immunoperoxidase staining in rare infiltrating cells within perivascular and subpial spaces. Thus, HIV-1 was isolated from brain 15 days after mistaken HIV-1 inoculation and 1 day after virus was first recovered from blood.
Davis
L E
LE
Neurology Service, Albuquerque Veterans Affairs Medical Center, NM 87108.
Hjelle
B L
BL
Miller
V E
VE
Palmer
D L
DL
Llewellyn
A L
AL
Merlin
T L
TL
Young
S A
SA
Mills
R G
RG
Wachsman
W
W
Wiley
C A
CA
D000368:Aged; D001345:Autoradiography; D001921:Brain / Q000382:microbiology*; D015658:HIV Infections / Q000382:microbiology* / Q000635:transmission; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D007049:Iatrogenic Disease; D007262:Infusions, Intravenous; D017708:Leukocyte Transfusion; D007962:Leukocytes / Q000382:microbiology; D008297:Male; D016133:Polymerase Chain Reaction