Cytomegalovirus encephalitis in patients with acquired immunodeficiency syndrome: An autopsy study of 30 cases and a review of the literature

S. Morgello, E. S. Cho, S. Nielsen, O. Devinsky, C. K. Petito

Research output: Contribution to journalReview article

192 Scopus citations


The pathology of cytomegalovirus (CMV) encephalitis was studied at autopsy in thirty patients with acquired immunodeficiency syndrome. Lesions could be segregated into five major categories: microglial nodules, isolated inclusion-bearing cells, focal parenchymal necrosis, necrotizing ventriculo-encephalitis, and necrotizing radiculo-myelitis. Microglial nodules and CMV inclusions were present in all brains. Microglial nodules were found with variable frequency and had greatest density in subcortical grey matter. Only a small percentage (average, 6.5 per cent) contained CMV inclusion-bearing cells. Isolated inclusion-bearing cells unaccompanied by microglial nodules or inflammatory infiltrates were seen in half the patients. CMV inclusions were identified in capillary endothelia, astrocytes, and neurons. Focal CMV necrosis, ventriculo-encephalitis, and radiculo-myelitis were less frequent. The presence of CMV inclusions in capillary endothelia suggests a vascular portal of entry for the virus into the central nervous system. The diffuse ependymal and/or subpial distribution of CMV in several patients suggests additional dissemination via the cerebrospinal fluid. Isolated inclusion-bearing cells may reflect the relative nonpermissiveness of surrounding central nervous system parenchyma for CMV infection.

Original languageEnglish (US)
Pages (from-to)289-297
Number of pages9
JournalHuman pathology
Issue number3
StatePublished - Mar 1987


ASJC Scopus subject areas

  • Pathology and Forensic Medicine

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