Subacute sclerosing panencephalitis (SSPE) had largely disappeared from the United States because of nearly universal measles vaccination, but it has reemerged in children infected with human immunodeficiency virus (HIV). Two children with SSPE are described. The first was HIV positive and presented with seizures and encephalopathy at the age of 21 months. The second developed myoclonus and dementia at age 4 years; she was not infected with HIV, but her mother had acquired immunodeficiency syndrome. Magnetic resonance imaging findings were nonspecific and could have been compatible with HIV encephalopathy. Electroencephalography was characteristic of SSPE, showing high-voltage, periodic slow-wave complexes and background slowing. The diagnosis of SSPE was confirmed by brain biopsy or high measles antibody titers in the cerebrospinal fluid.
Renal biopsies were performed on 18 patients afflicted with moderately severe or severe rheumatoid arthritis ranging from 20 to 58 years in age and with minimal to mild urine abnormalities. No abnormality was found in 11 cases. Seven biopsies revealed minimal increase in mesangial cells and matrix on light microscopy with focal tubular atrophy in some. Electron microscopy showed slight increase in mesangium, presence of ‘deposits’ in the latter and epithelial cells and fusion of podocytes in several places. Microtubular structures were found in one case. Immunofluorescent studies were negative in all cases.
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