An autopsy case of AIDS initially presenting with symptoms of myelopathy

An autopsy case of HIV encephalomyelopathy in a homosexual patient who initially presented with signs of myelopathy, such as urinary incontinence and spasticity of both legs, is reported. The pathological examination disclosed typical HIV encephalopathy with macrophages and multinucleated giant cells (MGC) in the cerebral white matter and loss of neurons of the cerebral cortex. The MGC contained HIV-1 p24 antigen. The thoracic spinal cord was markedly atrophied with degeneration of both lateral tracts, and histologically characterized by gliosis and perivascular accumulation of macrophages. Vacuolar changes and HIV-1 p24-containing cells were not observed in the spinal cord. The present case indicates that myelopathy can occur as an initial sign in AIDS patients, even though its pathomechanism remains to be elucidated.