Multiple Ischemic Infarcts in a Child with AIDS, Varicella Zoster Infection, and Cerebral Vasculitis Yitzchak Frank, MD*, Wilma Lim, MD+, Ellen Kahn, MD~, Peter Farmer, MD~:, Michael Gorey, MD~, and Savita Pahwa, MD + A 47+-year-old girl with acquired immunodeficiency syndrome and prolonged varicella zoster virus skin infection developed multiple ischemic strokes and radiologic and histopathologic evidence of central ner- vous system vasculitis. Typical features of acquired im- munodeficiency syndrome encephalitis were not pre- sent and there was no evidence of vasculitis outside the nervous system. Central nervous system vasculitis prob- ably resulted from varicella zoster virus infection that persisted because of immunodeficiency. This acquired immunodeficiency syndrome complication has only rarely been described in adults and to our knowledge has not been described in children. Frank Y, Lim W, Kahn E, Farmer P, Gorey M. Pahwa S. Multiple ischemic infarcts in a child with AIDS, varicella zoster infection, and cerebral vasculitis. Pediatr Neurol 1989;5:64-7. Introduction Neurologic abnormalities are common in acquired im- munodeficiency syndrome (AIDS) [1,2] and may reflect direct infection of neural tissue by human immunodeficien- cy virus (HIV) or other pathophysiologic mechanisms. Is- chemic infarcts of brain seldom occur in AIDS and have not been described previously in children with AIDS. We report a child with AIDS who had persistent varicella infection, cerebral vasculitis, and multiple cerebral infarcts. Case Report Tlais 47:-year-old girl wa.. hospitalized ~ith a 2 ~ da~. hN,r; (H '.ore nt)lcticc, letharg 3. ant)rcxia+ and zltaxla. DtniI+~ llit_' {h->i ? .';u ~, uf lil,." she had poor weight gait1, internlitlent di,3rrllctt, hcrpctw .t<+)+)atili-, ~md sCVelal episodes of oral candidiasit, and ()lili,+;. Ilcr 2.! ~t'ar ,rid nli)lhui was a heroin addict Wilt) loo~ 111ethadollC dIIIHI~ pI'C~IILIt]~. ~ At 3 vC;.llSof age. silo wLty.hospitalized Iol +'Z/pllcit.' zitla{_k..." lSxalnina tion revealed generalized lymphadenopalhy, hcpalonlc~;:ll), and clubhinQ of fingers. Chesl rociltgcnogranl dcillOllslraled ddhlst, inlelslilial in filtrate,< lung bh)p',} revealed I),mplloid inlcrxtitial pnculliOiiia. The diagnosis of AIDS \~,,as established by isolation el lilY Irt)lli periliheral blood lymphocylcs. Anlihodies to HIV ~tcre detected m ~t'rtlli/ hv ELISA and ~'csleril blot techniques. Thu lolal ilunihcl ()l lyinphocstcs was 6,9(-,~)1nn11~, T4 lynlphocylcs. 520, and T4/T,~ lalio, (). ]5 T cell and B cell fclnClions wore depressed. Shc had elcwttcd ~a,'runl liver c'n/ylnos. hypergamiruigh)bLilinenlia, and reversed hlood aibLunintgiobulill ralio. hnnlun(L'dobulhl therap) was insliluled, but inlctstilial imctununia persisted. /sit 3~/~ yczil<~ o1 age. she dc~elopcd valicella. Alicl /rc'allilclll ~ith in- IravenotlS acyclovir the lesions cleared, hut I nlonlh hller she developed a skin eruption in the "l'~-rtj dermaiotrles. Varicella zoslor t, il'US (VZV) was cullured froili the skin lesions: viral aoligell ~as identified by im- nlunofhiorescenl assay. Althougti she was lrealed wilh oral amyclovir, the lesions recurred and persisted. On her final hospitalization, examination revealed mulliplc, dry. crusted varicellilbrm vesicles, left hyperreflexia, left extensor plantar response, broad-based ataxic gait. blindness in the left eye {secondary t, Figure I. Initial contrast-enhanced a~Jal CT demonstrates abnormal .fiwal areas ~?[" decreased attenuation in the right basal ganglia region and right Wmporal lobe with mild associated mass eff~'ct. There is no evi¢lencc Q['a~nol'olal conll'asl cnhancemdn[. From the Departments of *Neurology, "Pediatrics, :E:Pathology. and ¶Radiology; North Shore University Hospital: Cornell University Medical College: Manhasset, New York. Communications should be addressed to: Dr. Frank: Department of Neurology (Pediah'ic Neurology t: North Shore University Hospital: 300 Community Drive: Manhasset, NY 11030. Received October 31, 1988: accepted December 14, 1988. 64 PEDIATRIC NEUROLOGY Vol. 5 No. 1