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Volume 27, Number 1—January 2021
Dispatch

Fatal Case of Chronic Jamestown Canyon Virus Encephalitis Diagnosed by Metagenomic Sequencing in Patient Receiving Rituximab

Isaac H. Solomon1Comments to Author , Vijay S. Ganesh1, Guixia Yu, Xian Ding Deng, Michael R. Wilson, Steve Miller, Tracey A. Milligan, Shibani S. Mukerji, Abigail Mathewson, Justin Linxweiler, Darlene Morse, Jana M. Ritter, J. Erin Staples, Holly Hughes, Carolyn V. Gould, Pardis C. Sabeti2, Charles Y. Chiu2, and Anne Piantadosi23
Author affiliations: Brigham and Women’s Hospital, Boston, Massachusetts, USA (I.H. Solomon, V.S. Ganesh, T.A. Milligan); Harvard Medical School, Boston (I.H. Solomon, V.S. Ganesh, T.A. Milligan, S.S. Mukerji, A. Piantadosi); Broad Institute, Cambridge, Massachusetts, USA (V.S. Ganesh, P.C. Sabeti, A. Piantadosi); University of California–San Francisco, San Francisco, California, USA (G. Yu, X.D. Deng, M.R. Wilson, S. Miller, C.Y. Chiu); Massachusetts General Hospital, Boston (S.S. Mukerji, A. Piantadosi); New Hampshire Division of Public Health Services, Concord, New Hampshire, USA (A. Mathewson, J. Linxweiler, D. Morse); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (J.M. Ritter); Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (J.E. Staples, H. Hughes, C.V. Gould); Harvard University, Cambridge (P.C. Sabeti); Harvard T.H. Chan School of Public Health, Boston (P.C. Sabeti); Howard Hughes Medical Institute, Chevy Chase, Maryland, USA (P.C. Sabeti)

Main Article

Figure 1

Brain imaging and autopsy findings in a case of chronic Jamestown Canyon virus (JCV) meningoencephalitis in a patient receiving rituximab, Boston, Massachusetts, USA. A) Brain magnetic resonance imaging T2-weighted fluid-attenuated inversion recovery showed mild atrophy with secondary ventriculomegaly but was otherwise unremarkable. B) Brain positron emission tomography with 2-deoxy-2-[fluorine-18] fluoro-D-glucose integrated with computed tomography showed global hypometabolism. Color scale ranges from blue-green (hypometabolic) to orange-white (hypermetabolic). C, D) Hematoxylin and eosin stained section of cerebral cortex at low magnification shows loss of neurons and perivascular chronic inflammation (C), compared with a JCV-negative control with a normal complement of cortical neurons (D). E, F) Higher-power magnification of cerebral cortex (E) and hippocampus (F) show microgliosis, microglial nodules, and neuronophagia (arrow). G, H) Severe Purkinje cell loss, Bergmann gliois (arrows), and microgliosis (arrowheads) of the molecular layer are present in the cerebellum (G), compared with a JCV-negative control with normal complement of Purkinje cells (H). I, J) Immunohistochemistry shows abundant perivascular, parenchymal, and leptomeningeal CD3+ T cells (I) and is negative for B-cell lineage–specific activator protein positive B cells (J). Panels C, D, I, and J, original magnification ×100; panels E, F, G, and H, original magnification ×200.

Figure 1. Brain imaging and autopsy findings in a case of chronic Jamestown Canyon virus (JCV) meningoencephalitis in a patient receiving rituximab, Boston, Massachusetts, USA. A) Brain magnetic resonance imaging T2-weighted fluid-attenuated inversion recovery showed mild atrophy with secondary ventriculomegaly but was otherwise unremarkable. B) Brain positron emission tomography with 2-deoxy-2-[fluorine-18] fluoro-D-glucose integrated with computed tomography showed global hypometabolism. Color scale ranges from blue-green (hypometabolic) to orange-white (hypermetabolic). C, D) Hematoxylin and eosin stained section of cerebral cortex at low magnification shows loss of neurons and perivascular chronic inflammation (C), compared with a JCV-negative control with a normal complement of cortical neurons (D). E, F) Higher-power magnification of cerebral cortex (E) and hippocampus (F) show microgliosis, microglial nodules, and neuronophagia (arrow). G, H) Severe Purkinje cell loss, Bergmann gliois (arrows), and microgliosis (arrowheads) of the molecular layer are present in the cerebellum (G), compared with a JCV-negative control with normal complement of Purkinje cells (H). I, J) Immunohistochemistry shows abundant perivascular, parenchymal, and leptomeningeal CD3+ T cells (I) and is negative for B-cell lineage–specific activator protein positive B cells (J). Panels C, D, I, and J, original magnification ×100; panels E, F, G, and H, original magnification ×200.

Main Article

1These authors contributed equally to this article.

2These senior authors contributed equally to this article.

3Current affiliation: Emory University, Atlanta, Georgia, USA.

Page created: September 23, 2020
Page updated: December 21, 2020
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