Fulminant JC virus encephalopathy with productive infection of cortical pyramidal neurons.
The polyomavirus JC (JCV) is the causative agent of progressive multifocal leukoencephalopathy and of JCV granule cell neuronopathy. We present a human immunodeficiency virus-negative patient who experienced development of multiple cortical lesions, aphasia, and progressive cognitive decline after chemotherapy for non-small-cell lung cancer. Brain biopsy and cerebrospinal fluid polymerase chain reaction demonstrated JCV, and she had a rapidly fatal outcome. Postmortem analysis showed diffuse cortical lesions and areas of necrosis at the gray-white junction. Immunostaining showed a productive JCV infection of cortical pyramidal neurons, confirmed by electron microscopy, with limited demyelination. This novel gray matter syndrome expands the scope of JCV clinical presentation and pathogenesis.
Wüthrich
Christian
C
Division of Viral Pathogenesis, Beth Israel Deaconess Medical Center, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Dang
Xin
X
Westmoreland
Susan
S
McKay
John
J
Maheshwari
Atul
A
Anderson
Matthew P
MP
Ropper
Allan H
AH
Viscidi
Raphael P
RP
Koralnik
Igor J
IJ
D000368:Aged; D002540:Cerebral Cortex / Q000473:pathology* / Q000821:virology; D005260:Female; D006801:Humans; D007577:JC Virus / Q000302:isolation & purification; D007968:Leukoencephalopathy, Progressive Multifocal / Q000175:diagnosis* / Q000821:virology; D017966:Pyramidal Cells / Q000473:pathology* / Q000821:virology