Fulminating adult-onset subacute sclerosing panencephalitis in a 49-year-old man.
BACKGROUND
Subacute sclerosing panencephalitis (SSPE) is a rare, slow viral infection caused by a defective measles virus. It is characterized by progressive mental deterioration associated with motor impairment and prominent myoclonus. In about 10% of all cases, the disease can progress rapidly and lead to death within a few months. The oldest previously reported fulminating case was in a 25-year-old man.


OBJECTIVE
To emphasize the relationship between retinal involvement and acute SSPE by reporting the case of a 49-year-old man with clinical, laboratory, and pathological evidence of acute SSPE.


METHODS
Hôpital de l'Enfant-Jésus, Quebec, Quebec.


METHODS
This man was referred to the Department of Neurological Sciences on March 21, 2001, because of recent behavioral changes and progressive cognitive impairment over the past few months. Medical history was unremarkable except for an episode of measles in his childhood. Neurological examination showed bilateral myoclonic jerks. Ophthalmic examination revealed bilateral macular swelling and papilledema. Electroencephalography showed periodic sharp and slow-wave discharges. Magnetic resonance imaging showed bilateral diffuse T2-signal hyperintensities in both periventricular and subcortical white matter. Cerebrospinal fluid antimeasles antibody titers were highly positive. An Omaya reservoir was inserted and therapy using a combination of high-dose intrathecal interferon alfa and oral isoprinosine were administered for 6 weeks. Despite transient subjective improvement in the patient's condition, it continued to deteriorate, he became bedridden, and he died on June 26, 2001.


CONCLUSIONS
To our knowledge, this patient is the oldest case of SSPE reported in the literature. This patient and other patients with acute SSPE associated with bilateral macular swelling described in the literature raised the possibility of measles virus-acquired virulent neurotropism in the retina before invading the central nervous system.
Gagnon
Alexis
A
Department of Neurological Sciences, Centre Hospitalier Affilié Universitaire de Québec-Hôpital de l'Enfant-Jésus, Quebec, Quebec, Canada.
Bouchard
Remi W
RW
D017668:Age of Onset; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001921:Brain / Q000473:pathology / Q000503:physiopathology; D004569:Electroencephalography; D017809:Fatal Outcome; D006801:Humans; D007074:Immunoglobulin G / Q000134:cerebrospinal fluid; D007542:Inosine Pranobex / Q000627:therapeutic use; D016898:Interferon-alpha / Q000008:administration & dosage / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012160:Retina / Q000473:pathology; D020133:Reverse Transcriptase Polymerase Chain Reaction; D013190:SSPE Virus / Q000276:immunology / Q000302:isolation & purification; D013344:Subacute Sclerosing Panencephalitis / Q000134:cerebrospinal fluid / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology*
D000998:Antiviral Agents; D007074:Immunoglobulin G; D016898:Interferon-alpha; D007542:Inosine Pranobex