We describe a bone marrow transplant patient with fatal subacute adenovirus meningoencephalitis, the first such patient reported. Neuropathological examination revealed unique, bilaterally symmetrical degeneration in the inferomedial temporal cortex, amygdaloid nuclei, hippocampi, hypothalamus, and some brainstem nuclei. Viral intranuclear inclusions were noted in these areas by light microscopy and confirmed by electron microscopy. identification was authenticated by viral culture and the isolation of adenovirus from cerebral cortical tissues, and further confirmed by immunofluorescence and serological methods. Davis D, Henslee PJ, Markesbery WR. Fatal adenovirus meningoencephalitis in a bone marrow transplant patient. Ann Neurol 1988;23:385-389 Approximately 48 to 70% of bone marrow transplant (BMT) patients develop CNS complications, about 6% of which are fatal fl, 2). These deaths are most commonly due to infectious agents [2]. This report describes a BMT patient who developed a fatal subacute viral meningoencephalitis in which adenovirus was the pathogenic agent.
Case Report
A 17-year-old woman was initially diagnosed as having acute myelogenous leukemia in August 1983. After her fourth remission, she underwent high-dose chemotherapy and total body irradiation (14 Gy). In June 1985 she received a haploidentical marrow graft and cyclosporin for prophylaxis of graft-versus-host disease (GVHD). Her posttransplant course was complicated by acute and chronic GVHD, chronic headaches, and an episode of disseminated herpes virus infection. For control of GVHD, she received longterm combined immunosuppression including cyclosporin, prednisone, and azathioprine. For antimicrobial prophylaxis, she received trimethoprim-sulfamethoxazole, acyclovir, erythromycin, and intravenous immunoglobulins. Supplemental multivitamins and thiamine were also administered. She did
From the Departments of +Pathology, "Internal Medicine and Pediatrics, and $Neurology,