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Figure 4 Autopsy immunochemistry results

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1 Figure 4 Autopsy immunochemistry results
Autopsy immunochemistry results CD68 (A) and ferritin (B) stain showed the presence of scattered microglial cells, foamy macrophages, and rare hemosiderin-laden macrophages. CD4 was negative for T cells (C). Other tests performed include staining T cell markers CD3, CD4, CD5, and CD8, as well as B cell marker CD20 (data not shown), all of which were negative. These results indicated a primarily macrophage reaction vs lymphocytic. Immunohistochemistry for immunoglobulin G (IgG) and IgM showed a perivascular double ring-like effect consistent with an autoimmune inflammatory reaction or leakage (arrows, D). Immunohistochemistry for myelin basic protein (MBP) showed areas of reduced staining in a perivascular distribution throughout the white matter (E). The U fibers were spared. There was perivascular edema, gliosis, and mild axonal damage seen on glial fibrillary acidic protein (GFAP) (F) and neurofilament stain (G). Of note, neurofilament stain showed minimal axonal damage in contrast to the MBP stain, which was most consistent with demyelination. Herpes simplex virus 1 and 2 staining was negative. Gram stain and silver stain were also performed, which were negative for infection. Rick Magun et al. Neurol Neuroimmunol Neuroinflamm 2016;3:e187 © 2016 American Academy of Neurology

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