Marchiafava-Bignami disease in an AIDS patient

Doença de Marchiafava-Bignami em um paciente com AIDS

A 40 year-old alcoholic man with AIDS developed acute encephalopathy and fever. Brain MRI showed a diffuse corpus callosum(CC) and periventricular white matter demyelinating lesions (Figure), suggestive of Marchiafava-Bignami disease (MBD). CD4 T lymphocyte count was 2/mm³, HIV viral load was 750000/mm³. CSF analysis was normal. Parenteral B vitamins were started with rapid improvement.

Figure
(A) Axial FLAIR image shows high signal intensity in anterior and posterior portions of the Corpus Callosum (white arrows) and periventricular white matter. (B) Sagital T1-weighted image shows low signal intensity along the entire lenght of the Corpus Callosum (white arrow).

MBD is metabolic disease characterized by demyelination of the CC, which occurs in severe alcoholism and malnourished states¹, rarely associated with AIDS. The main differential diagnosis of CC lesions are multiple sclerosis, lymphoma, viral encephalitis and stroke².

MBD must always be considered in alcoholics with encephalopathy despite of their immune status.

References

• ¹
  Hillbom M, Saloheimo P, Fujioka S, Wszolek ZK, Juvela S, Leone MA. Diagnosis and management of Marchiafava-Bignami disease: a review of CT/MRI confirmed cases. J Neurol Neurosurg Psychiatry. 2014;85(2):168-73. doi:10.1136/jnnp-2013-305979
• ²
  Renard D, Castelnovo G, Campello C, Bouly S, Le Floch A, Trouvenot E et al. An MRI review of acquired corpus callosum lesions. J Neurol Neurosurg Psychiatry. 2014;85(9):1041-8. doi:10.1136/jnnp-2013-307072

Publication Dates

• Publication in this collection
  20 Oct 2015
• Date of issue
  Feb 2016

History

• Received
  23 June 2015
• Reviewed
  22 Aug 2015
• Accepted
  14 Sept 2015