SUBACUTE MEASLES ENCEPHALITIS WITH AIDS DIAGNOSED BY FINE-NEEDLE ASPIRATION BIOPSY - A CASE-REPORT

BACKGROUND: Subacute measles encephalitis (SME), or measles inclusion body encephalitis (MIBE), is a rare central nervous system (CNS) compl ication following suing infection by the measles (rubeola) virus. It u sually occurs in young patients with defective cellular immunity from either congenital or aquired causes. In the United States, with the re surgence of measles infection and the human immunodeficiency virus (HI V) pandemic, subacute measles encephalitis should be added to the diff erential diagnosis in acquired immune deficiency syndrome (AIDS) patie nts presenting with unexplained CNS manifestations. CASE: A 2-year-old , HIV-positive, white male Teas admitted for generalized convulsive se izures. Vaccination was described as ''up to date.'' Despite treatment with anticonvulsive drugs, the child continued to develop frequent pa rtial and generalized seizures. Cephalic computed tomography and magne tic resonance imaging revealed a hypodense area in the right parietote mporal cortex without an associated mass effect. Fine needle aspiratio n biopsy (FNAB) of the affected area showed neuronal reduction, degene ration with eosinophilic int ranuclear inclusions, perivascular lympho plasmacytic infiltration and gliosis. Electron microscopy of the intra nuclear inclusions revealed fine, fibrillar, tubular nucleocapsids, co nsistent with the measles virus. CONCLUSION: Acute measles encephaliti s (AME), subacute sclerosing panencephalitis (SSPE), and SME are the t hree CNS syndromes associated with measles infection. Serum and cerebr ospinal fluid (CSF) antibody titers against measles virus are usually high and helpful in the diagnosis of AME and SSPE. In SME, neither ser um nov CSF antibody titers against measles virus are high. Therefore, FNAB is necessary for a definitive diagnosis.