Human pegivirus-1 associated leukoencephalitis: Clinical and molecular features

Ann Neurol. 2018 Nov;84(5):781-787. doi: 10.1002/ana.25343. Epub 2018 Nov 8.

Abstract

Etiologic diagnosis is uncertain in 35% to 50% of patients with encephalitis, despite its substantial global prevalence and disease burden. We report on 2 adult female patients with fatal leukoencephalitis associated with human pegivirus-1 (HPgV-1) brain infection. Neuroimaging showed inflammatory changes in cerebral white matter. Brain-derived HPgV-1 RNA sequences clustered phylogenetically with other pegiviruses despite an 87-nucleotide deletion in the viral nonstructural (NS)2 gene. Neuropathology disclosed lymphocyte infiltration and gliosis predominantly in brain white matter. HPgV-1 NS5A antigen was detected in lymphocytes as well as in astrocytes and oligodendrocytes. HPgV-1 neuroadaptation should be considered in the differential diagnosis of progressive leukoencephalitis in humans. Ann Neurol 2018;84:789-795.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Encephalitis / pathology*
  • Encephalitis / virology*
  • Fatal Outcome
  • Female
  • Flavivirus
  • Flavivirus Infections / pathology*
  • Humans
  • Leukoencephalopathies / pathology*
  • Leukoencephalopathies / virology*
  • Middle Aged