Rash, Encephalitis, and Temporal Cortex Biopsy! - USMLE Forums
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Old 10-23-2011
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Neuro Rash, Encephalitis, and Temporal Cortex Biopsy!

a 3-day-old girl develops numerous skin lesions followed soon thereafter by severe encephalitis. Despite extensive treatment, she dies a few days later. An autopsy from temporal cortex with close-up view of a nucleus is shown below:

Rash, Encephalitis, and Temporal Cortex Biopsy!-biopsy2.jpg
click image to enlarge

Autopsy from other organs revealed that the girl had a multi-systemic infection. Which of the following is the most likely infectious agent?

A) CMV
B) HSV
C) Rubella
D) Toxoplasma
E) Rabies
F) Syphilis
G) Meningococcus

---
The figure was adopted from the following site:
http://www.urmc.rochester.edu/hslt/c...b/slide127.cfm
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Old 10-23-2011
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temporal lobe HSV
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Old 10-23-2011
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yes temporal lobe HSV
but can you please explain the rash and the multiorgan distribution? and what we saw in the nucleus
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Old 10-23-2011
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Post Too vague/tricky

What about "Meningococcus"?
It can be acquired as congenital fulminant agressive infection involving multiple body systems (meningococcemia) along with rashes.


Howeve, the question is too tricky. Biopsy gives no clue unless someone is Certified Pathologist. It can be "inclusion bodies reflecting CMV infection" or even isolated cocci.
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Old 10-23-2011
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Correct Answer Answer

Quote:
Originally Posted by dr.muhamad View Post
yes temporal lobe HSV
but can you please explain the rash and the multiorgan distribution? and what we saw in the nucleus
All right,
It's a case of HSV systemic infection involving the brain.
In the disseminated HSV infection, cell nuclei contain Cowdry A inclusions.
CMV has Cowdry A nuclear inclusions but, in addition, has multiple cytoplasmic inclusions and greatly increased cell size.
Moreover, HSV encephalitis usually involves temporal lobe, as seen in this case.

Cowdry type A inclusions occur in some viral diseases, such as HSV, CMV, measles, but are not present in many others.
Other figures:
http://scielo.isciii.es/scielo.php?p...pt=sci_arttext

Last edited by Evergreen; 10-23-2011 at 07:13 PM.
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Old 10-24-2011
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B) HSV encephalitis
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Old 10-24-2011
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Hi Evergreen, thank you for posting such an interesting question. I learned from your following explanation. May I know where the question comes from? It is from UW or Kaplan Qbank or any other resources?

Again, I appreciate your reply!
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Old 10-24-2011
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Quote:
Originally Posted by belindalimm View Post
Hi Evergreen, thank you for posting such an interesting question. I learned from your following explanation. May I know where the question comes from? It is from UW or Kaplan Qbank or any other resources?

Again, I appreciate your reply!

Answer of this question is in your First Aid 2011 check out page 167 and also ToRCHeS infections on Herpes Simplex virus neonatal manifestations on page 179 of FA 2011.
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Quote:
Originally Posted by LatinGeorge View Post
Answer of this question is in your First Aid 2011 check out page 167 and also ToRCHeS infections on Herpes Simplex virus neonatal manifestations on page 179 of FA 2011.
Thank you, LatinGeorge! FA is the bible for USMLE. Love that reference!! I'm sure FA gives the clear explanation. But I'm still wondering the origin of the question.
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Old 10-24-2011
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Quote:
Originally Posted by belindalimm View Post
Thank you, LatinGeorge! FA is the bible for USMLE. Love that reference!! I'm sure FA gives the clear explanation. But I'm still wondering the origin of the question.
It was from Lange, but I modified it a little bit.
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