PMC5749436_01
Timeline of key events surrounding the illness of a patient with GBS and confirmed Zika virus infection, Puerto Rico, 2016. AIDP, acute inflammatory demyelinating polyneuropathy; CT, computed tomography; ED, emergency department; GBS, Guillain-Barre syndrome; ICU, intensive care unit.
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In August 2016, a 78-year-old man living in the San Juan metropolitan area with a medical history of hypertension (for which he was taking amlodipine), diabetes, asthma, and prostate cancer visited a hospital emergency department with a 4-day history of worsening paresthesia of the lower and upper extremities and progressive bilateral lower and upper extremity weakness (Figure 1).
Histopathologic evaluation of tissue specimens collected postmortem from a patient with Guillain-Barre syndrome (acute demyelinating inflammatory polyneuropathy variant) and Zika virus infection, Puerto Rico, 2016. A, B) Luxol fast blue-periodic acid-Schiff myelin stain of sciatic nerves show patchy myelin loss and variable inflammation. Original magnification x10(A) and x20(B). C) Detection of CD68-positive cells (microphages) by immunohistochemistry (arrows) in sciatic nerve. Original magnification x20. D) Hematoxylin and eosin stain of cranial nerve IV shows perivascular lymphocytic infiltrate. Original magnification x20. E) Detection of T-lymphocytes by immunohistochemistry (arrows) in the same area where lymphocytic infiltrates were observed by hematoxylin and eosin stain. Original magnification x40.
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Myelin loss was highlighted by luxol fast blue staining (Figure 2).