Leucoencefalitis aguda hemorrágica de Weston Hurst. Estudio neuropatológico de un caso

Introduction. Acute hemorrhagic leukoencephalitis (AHL), or Hurst disease is a rare, usuallyfatal, disease, probably due to an autoimmune cross reaction against myelin antigens present in the central nervous system, and which forms a spectrum of post-infeccious demyelinating diseases with acute disseminated encephalomyelitis. Casereport. The patient was a 21 year old femals who presented with an acute encephalopathy and generalized seizures following a 15 day febrile syndrome attributed to amygdalitis; a laboratory work-up, including CSF, was non-diagnostic, and a brain CTscan revealed diffuse cerebral edema. After 12 days the patient died from nosocomial pneumonia and multi-organ failure; neuropathological examination of the brain confirmed the diagnosis of Hurst acute hemorrhagic leukoencephalitis, with a weak perilesional inflammatory reaction, unlike the usual picture in AHL. Discussion. AHL should be apart of the differential diagnosis of acute encephalopathic diseases, particularly if preceded by systemic infections. The atypical laboratory findings, and the impossibilty of performing a brain MRI were obstacles to the diagnosis in this case. The relative paucity of the perivascular infiltrate is an atypical finding, and could be due to apoptotic clearance of the inflammatory cells, as has been described in other autoimmune demyelinating diseases.