Brett L. Cucchiara, MD, Mark S. Forman, MD, PhD, Michael L

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Fatal Subacute Cytomegalovirus Encephalitis Associated With Hypogammaglobulinemia and Thymoma Brett L. Cucchiara, MD, Mark S. Forman, MD, PhD, Michael L. McGarvey, MD, Scott E. Kasner, MD, David King, MD Mayo Clinic Proceedings Volume 78, Issue 2, Pages 223-227 (February 2003) DOI: 10.4065/78.2.223 Copyright © 2003 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 1 Brain magnetic resonance imaging (MRI) studies. A and B, Axial MRI fluid-attenuated inversion recovery images at presentation show increased signal in the cerebellar vermis and periventricular white matter. C and D, Follow-up images (same sequences and levels) 16 days later show progression of signal abnormality in the cerebellar vermis and periventricular white matter with extension across the corpus callosum. Mayo Clinic Proceedings 2003 78, 223-227DOI: (10.4065/78.2.223) Copyright © 2003 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure 2 Cytomegalovirus meningoventriculoencephalitis. A, Cerebellum at the level of the dentate nucleus with multiple hemorrhagic foci in the right dentate nucleus (arrowhead) and vermis (arrow). B, Marked necrosis and hemorrhage (arrow) within the periaqueductal gray matter in the pons at the level of the locus ceruleus. Note the ependymal lining is largely denuded (arrowheads); also note the numerous cells with large eosinophilic cytoplasmic inclusions (hematoxylineosin, original magnification x100). C, High-power magnification of cells with prominent viral cytopathic effect within the periaqueductal gray matter characterized by large, glassy eosinophilic cytoplasmic inclusions and large basophilic, intranuclear inclusions (hematoxylineosin, original magnification x200). D, These cells were strongly positive by immunohistochemistry for cytomegalovirus (CMV) antigens (arrows) (anti-CMV early and immediate early antigens, original magnification x400). Mayo Clinic Proceedings 2003 78, 223-227DOI: (10.4065/78.2.223) Copyright © 2003 Mayo Foundation for Medical Education and Research Terms and Conditions