CD8-Positive T-Cell Leukoencephalitis With Astrocytopathy Clinically Presenting as Neuromyelitis Optica.
We describe a novel disease entity with the clinical and radiologic presentation of neuromyelitis optica (NMO) and widespread CD8-positive T-cell leukoencephalitis and astrocytopathy. The 59-year-old female patient had a complex 2-year neurological history that included early changes in cognition and memory, progressive lower extremity motor dysfunction, and multimodal sensory involvement. MRI of the spinal cord showed increased T2 signal in the central cord extending from C2 through T4. MRI of the brain showed symmetric radial enhancement in periventricular deep white matter without evidence of demyelinating lesions. The constellation of findings met clinical criteria for NMO. Steroid treatment was initiated with subjective improvement but she developed urosepsis and died at age 61 years. At autopsy, the spinal cord showed typical NMO findings but no evidence of complement deposition or neutrophil infiltration. There was diffuse CD8-positive T-cell infiltration and CD68-positive macrophage activation throughout subcortical white matter, optic chiasm, brainstem, and spinal cord. This was accompanied by marked astrocytopathy in all areas. Serum was negative for aquaporin-4 autoantibodies suggesting a nonhumoral basis of astrocyte damage. This first example of CD8-positive T-cell leukoencephalitis in a patient with a clinical presentation of NMO may explain the recalcitrance of some patients to therapies targeting humoral immunity.
From the Division of Neuropathology, University of Pittsburgh, Pittsburgh, Pennsylvania
Diana L
DL
Thomas
Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania|Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania
Jody
J
Manners
Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania
Daniel
D
Marker
Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania|Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania
Joseph
J
Mettenburg
From the Division of Neuropathology, University of Pittsburgh, Pittsburgh, Pennsylvania
Geoffrey
G
Murdoch
Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania
Bryan
B
Stevens
From the Division of Neuropathology, University of Pittsburgh, Pittsburgh, Pennsylvania
Guoji
G
Wang
From the Division of Neuropathology, University of Pittsburgh, Pittsburgh, Pennsylvania
Clayton
C
Wiley
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D015703:Antigens, CD / Q000032:analysis; D015214:Antigens, Differentiation, Myelomonocytic / Q000032:analysis; D001253:Astrocytes / Q000473:pathology*; D001344:Autopsy; D018414:CD8-Positive T-Lymphocytes; D003711:Demyelinating Diseases / Q000000981:diagnostic imaging / Q000473:pathology*; D004660:Encephalitis / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D009471:Neuromyelitis Optica / Q000000981:diagnostic imaging / Q000473:pathology*; D013116:Spinal Cord / Q000473:pathology; D066127:White Matter / Q000473:pathology; D000097382:CD68 Molecule
D000893:Anti-Inflammatory Agents; D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D008775:Methylprednisolone; C067980:CD68 antigen, human; D000097382:CD68 Molecule
Aquaporin-4; Astrocytopathy; Demyelinating disease; Neuromyelitis optica; T cells