Encefalite herpética disseminada: apresentação de um caso autopsiado com estudo imuno-histoquímico

Pittella, José Eymard Homem; Bacchi, Carlos Eduardo; Robb, James

doi:10.1590/S0004-282X1989000400011

Resumos

Relata-se um caso autopsiado de encefalite herpética disseminada em criança de um ano e três meses. O paciente era sadio até a moléstia atual quando apresentou febre, crises convulsivas repetidas e alterações de consciência que progrediram para o coma, evoluindo ao óbito em oito dias. O quadro neuropatológico era caracterizado por necrose e inflamação em focos múltiplos disseminados nos hemisférios cerebrais, tronco encefálico e cerebelo. A técnica da Avidina-Biotina-Peroxidase revelou, em neurônios do tálamo, imunor-reatividade intra-citoplasmática e muito raramente intranuclear para antígeno do herpes-vírus tipo 1. Este caso difere dos demais de encefalite herpética descritos na literatura em dois aspectos: (1) pela disseminação das lesões, em contraste com as formas limitadas topograficamente ao sistema límbico e, menos comumente, ao tronco encefálico; (2) pela presença de necrose, inflamação e hemorragias focais, alterações estas praticamente ausentes nos casos de encefalite disseminada tipicamente descritos em indivíduos imunodeprimidos.

An autopsied case of disseminated herpetic encephalitis in a previously healthy one-year-and-three-month-olu child is reported. He had fever, repeated convulsive crises and alterations of consciousness which progressed into a coma, leading to death in eight days. The neuropathological picture was characterized by necrosis and inflammation in multiple foci disseminated in the cerebral hemispheres, brainstem and cerebellum. The Avidin-Biotin-Peroxidase Complex technique showed, in neurons of the thalamus, intra-cytoplasmatic immunoreactivity, and, very rarely, intranuclear for the Herpes simplex virus type 1 antigens. This case differs from the other herpetic encephalitis ones described in the literature in two aspects: (1) by the dissemination of the lesions, in contrast with the forms topographically limited to the limbic system and, less commonly, to the brainstem; (2) by the presence of necrosis, inflammation and focal hemorrhage, which are alterations that practically do not exist in cases of disseminated encephalitis tipically described in immuno-depressed individuals.

Encefalite herpética disseminada: apresentação de um caso autopsiado com estudo imuno-histoquímico

Disseminated herpetic encephalitis: report of an autopsied case with immunohistochemical study

José Eymard Homem Pittella^I; Carlos Eduardo Bacchi^II; James Robb^III

^ILaboratório de Neuropatologia, Departamento de Anatomia Patológica e Medicina Legal, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte

^IIDepartamento de Patologia, Faculdade de Medicina da Universidade Estadual e São Paulo, Botucatu

^IIIDepartment of Pathology, Scripps Clínic and Research Foundation, La Jolla, California, USA

RESUMO

Relata-se um caso autopsiado de encefalite herpética disseminada em criança de um ano e três meses. O paciente era sadio até a moléstia atual quando apresentou febre, crises convulsivas repetidas e alterações de consciência que progrediram para o coma, evoluindo ao óbito em oito dias. O quadro neuropatológico era caracterizado por necrose e inflamação em focos múltiplos disseminados nos hemisférios cerebrais, tronco encefálico e cerebelo. A técnica da Avidina-Biotina-Peroxidase revelou, em neurônios do tálamo, imunor-reatividade intra-citoplasmática e muito raramente intranuclear para antígeno do herpes-vírus tipo 1. Este caso difere dos demais de encefalite herpética descritos na literatura em dois aspectos: (1) pela disseminação das lesões, em contraste com as formas limitadas topograficamente ao sistema límbico e, menos comumente, ao tronco encefálico; (2) pela presença de necrose, inflamação e hemorragias focais, alterações estas praticamente ausentes nos casos de encefalite disseminada tipicamente descritos em indivíduos imunodeprimidos.

SUMMARY

An autopsied case of disseminated herpetic encephalitis in a previously healthy one-year-and-three-month-olu child is reported. He had fever, repeated convulsive crises and alterations of consciousness which progressed into a coma, leading to death in eight days. The neuropathological picture was characterized by necrosis and inflammation in multiple foci disseminated in the cerebral hemispheres, brainstem and cerebellum. The Avidin-Biotin-Peroxidase Complex technique showed, in neurons of the thalamus, intra-cytoplasmatic immunoreactivity, and, very rarely, intranuclear for the Herpes simplex virus type 1 antigens. This case differs from the other herpetic encephalitis ones described in the literature in two aspects: (1) by the dissemination of the lesions, in contrast with the forms topographically limited to the limbic system and, less commonly, to the brainstem; (2) by the presence of necrosis, inflammation and focal hemorrhage, which are alterations that practically do not exist in cases of disseminated encephalitis tipically described in immuno-depressed individuals.

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Dr. José Eymard Homem Pittella - Departamento de Anatomia Patológica e Medicina Legal, Faculdade de Medicina da VFMG - Av. Alfredo Balena 190 - 30130 Belo Horizonte MG - Brasil.

Referências bibliográficas

1. Budka H, Popow-Kraupp T - Rabies and herpes simplex virus encephalitis: an immuno-histological study on site and distribution of viral antigens. Virchows Arch A 390: 353, 1981.
2. Cole GA, Wisseman CLJr - Pathogenesis of type dengue virus infection in suckling, weanling and adult mice: I. The relation of virus replication to interferon and antibody formation. Am J Epid 89: 669, 1969.
3. Damasio AR, van Hoesen GW - The limbic system and the localisation of herpes simplex encephalitis. J Neurol Neurosurg Psychiat 48: 297, 1985.
4. Davis JM, Davis KR, Kleinman GM, Kirchner HS, Taveras JM - Computed tomography of herpes simplex encephalitis, with clinicopathological correlation. Radiology 129: 409, 1978.
5. Dayan AD, Goody W, Harrison MJG, Rudge P - Brain stem encephalitis caused by herpesvirus hominis. Br Med J 4: 405, 1972.
6. Dinn JJ - Distribution of herpes simplex virus in acute necrotising encephalitis. J Path 129: 135, 1979.
7. Dinn JJ - Transolfactory spread of virus in herpes simplex encephalitis. Br Med J 281: 1392, 1980.
8. Esiri MM - Herpes simplex encephalitis: an immunohistological study of the distribution of viral antigen within the brain. J Neurol Sci 54: 209, 1982.
9. Hirsch MS, Zisman B, Allison AC - Macrophages and age-dependent resistance to herpes simplex virus in mice. J Immunol 104: 1160, 1970.
10. Hotson JR, Pedley TA - The neurological complications of cardiac transplantation. Brain 99: 673, 1976.
11. Hsu S-M, Raine L, Fanger H - Use of avidin-biotin-peroxidase complex (ABC) in immunoperoxidase techniques: a comparison between ABC and unlabeled antibody (PAP) procedures. J Histochem Cytochem 29: 577, 1981.
12. Hume Adams J, Jennett WB - Acute necrotizing encephalitis: a problem in diagnosis. J Neurol Neurosurg Psychiat 30: 248, 1967.
13. Johnson RT - The pathogenesis of herpes virus encephalitis: II. A cellular basis for the development of resistance with age, J Exper Med 120: 359, 1964.
14. Johnson RT, Mims CA - Pathogenesis of viral infections of the nervous system. N Engl J Med 278: 84, 1968.
15. Levitt P - A monoclonal antibody to limbic system neurons. Science 223: 299, 1984.
16. Levy RM, Bredesen DE, Rosenblum ML - Neurological manifestations of the acquired immunodeficiency syndrome (AIDS): experience at UCSF and review of the literature. J Neurosurg 62: 475, 1985.
17. Longson M, Bailey AS - Herpes encephalitis. In Waterson AP (ed): Clinical Virology. Churchill Livingstone, Edinburgh, 1977, Vol 1, pg 1.
18. Manz HJ - Pathology and pathogenesis of viral infections of the central nervous system. Hum Pathol 8: 3, 1977.
19. Miller JK, Hesser F, Tompkins VC - Herpes simplex encephalitis: report of 20 cases. Ann Intern Med 64: 92, 1966.
20. Perentes E, Herbort C - Herpes simplex virus encephalitis: a case with Korsakoff's syndrome and an immunoperoxydase study of 12 cases. Schweizer Arch Neurol Neurochir Psychiatr 135: 229, 1984.
21. Peters G - Klinische Neuropathology. Spezielle Pathologie der Krankhelten des zentralen und peripheren Nervensystems. Aufl 2. Georg Thieme Verlag, Stuttgart, 1970, pg 23.
22. Pittella JEH, Leite VHR, Lana-Peixoto MA, Bacchi CE - Encefalite herpética do tronco encefálico: relato de um caso autopsiado com estudo imuno-histoquímico e ao microscópio eletrônico. Arq Neuro-Psiquiat (São Paulo) 45: 44, 1987.
23. Price R, Chernik NL, Horta-Barbosa L, Posner JB - Herpes simplex encephalitis in an anergic patient. Am J Med 54: 222, 1973.
24. Román-Campos G, Toro G - Herpetic brainstem encephalitis. Neurology 30: 981, 1980.
25. Sellmeyer E, Bhettay E, Truswell AS, Meyers OL, Hansen JDL - Lymphocyte transformation in malnourished children. Arch Dis Child 47: 429, 1972.
26. White CL, Taxy JB - Early morphologic diagnosis of herpes simplex virus encephalitis: advantages of electron microscopy and immunoperoxidase staining. Hum Pathol 14: 135, 1983.
27. Zlotnik I, Smith CEG, Grant DP, Peacock S - The effect of immunosupression on viral encephalitis, with special reference to cyclophosphamide. Br J Exp Path 51: 434, 1970.

Datas de Publicação

Publicação nesta coleção
01 Jun 2011
Data do Fascículo
Dez 1989

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Budka H, Popow-Kraupp T - Rabies and herpes simplex virus encephalitis: an immuno-histological study on site and distribution of viral antigens. Virchows Arch A 390: 353, 1981.

[2] 2. Cole GA, Wisseman CLJr - Pathogenesis of type dengue virus infection in suckling, weanling and adult mice: I. The relation of virus replication to interferon and antibody formation. Am J Epid 89: 669, 1969.

[3] 3. Damasio AR, van Hoesen GW - The limbic system and the localisation of herpes simplex encephalitis. J Neurol Neurosurg Psychiat 48: 297, 1985.

[4] 4. Davis JM, Davis KR, Kleinman GM, Kirchner HS, Taveras JM - Computed tomography of herpes simplex encephalitis, with clinicopathological correlation. Radiology 129: 409, 1978.

[5] 5. Dayan AD, Goody W, Harrison MJG, Rudge P - Brain stem encephalitis caused by herpesvirus hominis. Br Med J 4: 405, 1972.

[6] 6. Dinn JJ - Distribution of herpes simplex virus in acute necrotising encephalitis. J Path 129: 135, 1979.

[7] 7. Dinn JJ - Transolfactory spread of virus in herpes simplex encephalitis. Br Med J 281: 1392, 1980.

[8] 8. Esiri MM - Herpes simplex encephalitis: an immunohistological study of the distribution of viral antigen within the brain. J Neurol Sci 54: 209, 1982.

[9] 9. Hirsch MS, Zisman B, Allison AC - Macrophages and age-dependent resistance to herpes simplex virus in mice. J Immunol 104: 1160, 1970.

[10] 10. Hotson JR, Pedley TA - The neurological complications of cardiac transplantation. Brain 99: 673, 1976.

[11] 11. Hsu S-M, Raine L, Fanger H - Use of avidin-biotin-peroxidase complex (ABC) in immunoperoxidase techniques: a comparison between ABC and unlabeled antibody (PAP) procedures. J Histochem Cytochem 29: 577, 1981.

[12] 12. Hume Adams J, Jennett WB - Acute necrotizing encephalitis: a problem in diagnosis. J Neurol Neurosurg Psychiat 30: 248, 1967.

[13] 13. Johnson RT - The pathogenesis of herpes virus encephalitis: II. A cellular basis for the development of resistance with age, J Exper Med 120: 359, 1964.

[14] 14. Johnson RT, Mims CA - Pathogenesis of viral infections of the nervous system. N Engl J Med 278: 84, 1968.

[15] 15. Levitt P - A monoclonal antibody to limbic system neurons. Science 223: 299, 1984.

[16] 16. Levy RM, Bredesen DE, Rosenblum ML - Neurological manifestations of the acquired immunodeficiency syndrome (AIDS): experience at UCSF and review of the literature. J Neurosurg 62: 475, 1985.

[17] 17. Longson M, Bailey AS - Herpes encephalitis. In Waterson AP (ed): Clinical Virology. Churchill Livingstone, Edinburgh, 1977, Vol 1, pg 1.

[18] 18. Manz HJ - Pathology and pathogenesis of viral infections of the central nervous system. Hum Pathol 8: 3, 1977.

[19] 19. Miller JK, Hesser F, Tompkins VC - Herpes simplex encephalitis: report of 20 cases. Ann Intern Med 64: 92, 1966.

[20] 20. Perentes E, Herbort C - Herpes simplex virus encephalitis: a case with Korsakoff's syndrome and an immunoperoxydase study of 12 cases. Schweizer Arch Neurol Neurochir Psychiatr 135: 229, 1984.

[21] 21. Peters G - Klinische Neuropathology. Spezielle Pathologie der Krankhelten des zentralen und peripheren Nervensystems. Aufl 2. Georg Thieme Verlag, Stuttgart, 1970, pg 23.

[22] 22. Pittella JEH, Leite VHR, Lana-Peixoto MA, Bacchi CE - Encefalite herpética do tronco encefálico: relato de um caso autopsiado com estudo imuno-histoquímico e ao microscópio eletrônico. Arq Neuro-Psiquiat (São Paulo) 45: 44, 1987.

[23] 23. Price R, Chernik NL, Horta-Barbosa L, Posner JB - Herpes simplex encephalitis in an anergic patient. Am J Med 54: 222, 1973.

[24] 24. Román-Campos G, Toro G - Herpetic brainstem encephalitis. Neurology 30: 981, 1980.

[25] 25. Sellmeyer E, Bhettay E, Truswell AS, Meyers OL, Hansen JDL - Lymphocyte transformation in malnourished children. Arch Dis Child 47: 429, 1972.

[26] 26. White CL, Taxy JB - Early morphologic diagnosis of herpes simplex virus encephalitis: advantages of electron microscopy and immunoperoxidase staining. Hum Pathol 14: 135, 1983.

[27] 27. Zlotnik I, Smith CEG, Grant DP, Peacock S - The effect of immunosupression on viral encephalitis, with special reference to cyclophosphamide. Br J Exp Path 51: 434, 1970.