title: Zika Virus Meningoencephalitis in an Immunocompromised Patient.
abstract: The World Health Organization considers the Zika virus (ZIKV) outbreak in the Americas a global public health emergency. The neurologic complications due to ZIKV infection comprise microcephaly, meningoencephalitis, and Guillain-Barré syndrome. We describe a fatal case of an adult patient receiving an immunosuppressive regimen following heart transplant. The patient was admitted with acute neurologic impairment and experienced progressive hemodynamic instability and mental deterioration that finally culminated in death. At autopsy, a pseudotumoral form of ZIKV meningoencephalitis was confirmed. Zika virus infection was documented by reverse trancriptase-polymerase chain reaction, immunohistochemistry, and immunofluorescence and electron microscopy of the brain parenchyma and cerebral spinal fluid. The sequencing of the viral genome in this patient confirmed a Brazilian ZIKV strain. In this case, central nervous system involvement and ZIKV propagation to other organs in a disseminated pattern is quite similar to that observed in other fatal Flaviviridae viral infections.
authors.affiliation: Cardiology Centre, Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, Brazil. Electronic address: pedrovs@usp.br.
authors.forename: Pedro V
authors.initials: PV
authors.lastname: Schwartzmann
authors.affiliation: Cardiology Centre, Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, Brazil.
authors.forename: Leandra N Z
authors.initials: LN
authors.lastname: Ramalho
authors.affiliation: Cardiology Centre, Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, Brazil.
authors.forename: Luciano
authors.initials: L
authors.lastname: Neder
authors.affiliation: Cardiology Centre, Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, Brazil.
authors.forename: Fernando C
authors.initials: FC
authors.lastname: Vilar
authors.affiliation: Cardiology Centre, Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, Brazil.
authors.forename: Sílvia M
authors.initials: SM
authors.lastname: Ayub-Ferreira
authors.affiliation: Cardiology Centre, Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, Brazil.
authors.forename: Marília F
authors.initials: MF
authors.lastname: Romeiro
authors.affiliation: Cardiology Centre, Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, Brazil.
authors.forename: Osvaldo M
authors.initials: OM
authors.lastname: Takayanagui
authors.affiliation: Cardiology Centre, Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, Brazil.
authors.forename: Antonio C
authors.initials: AC
authors.lastname: Dos Santos
authors.affiliation: Cardiology Centre, Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, Brazil.
authors.forename: André
authors.initials: A
authors.lastname: Schmidt
authors.affiliation: Cardiology Centre, Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, Brazil.
authors.forename: Luiz T M
authors.initials: LT
authors.lastname: Figueiredo
authors.affiliation: Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL.
authors.forename: Ross
authors.initials: R
authors.lastname: Arena
authors.affiliation: Cardiology Centre, Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, Brazil.
authors.forename: Marcus V
authors.initials: MV
authors.lastname: Simões
mesh_terms: D000208:Acute Disease; D000328:Adult; D002555:Cerebrospinal Fluid / Q000821:virology; D017809:Fatal Outcome; D005455:Fluorescent Antibody Technique / Q000379:methods; D016679:Genome, Viral; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D016867:Immunocompromised Host; D007150:Immunohistochemistry; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D008590:Meningoencephalitis / Q000000981:diagnostic imaging / Q000276:immunology / Q000821:virology*; D059906:Neuroimaging; D000072356:Parenchymal Tissue / Q000821:virology; D020133:Reverse Transcriptase Polymerase Chain Reaction; D000071244:Zika Virus / Q000235:genetics / Q000302:isolation & purification*; D000071243:Zika Virus Infection / Q000150:complications* / Q000175:diagnosis / Q000276:immunology
chemical_list: D007166:Immunosuppressive Agents