Which histologic findings are characteristic of HIV-associated vacuolar myelopathy (VM)?

Updated: May 07, 2018
  • Author: Krupa Pandey, MD; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Answer

Answer

Histologic findings may indicate multifocal, occasionally asymmetric vacuolation and myelin pallor involving the dorsal and lateral tracts more than the anterior and anterolateral tracts and involving the cervical and thoracic segments more than the lumbar segments or the brainstem, accompanied by astrogliosis. (See the images below.)

Spinal cord from patient with vacuolar myelopathy Spinal cord from patient with vacuolar myelopathy that shows extensive spongiform changes in the white matter (Luxol fast blue stain) (contributed by Dr. Beth Levy, Saint Louis University School of Medicine, St. Louis, MO).
Marked vacuolation is apparent in this Luxol fast Marked vacuolation is apparent in this Luxol fast blue stained photomicrograph (contributed by Dr. Beth Levy, Saint Louis University School of Medicine, St. Louis, MO).

HIV-infected, activated, lipid-laden macrophages and microglia expressing interleukin-1 and/or tumor necrosis factor-alpha may be seen. [9, 10] On electron microscopy, intramyelinic or periaxonal vacuoles and, rarely, disrupted axons may be seen.

The histology resembles subacute combined degeneration from vitamin B-12 deficiency. [11]


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