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. 2021 Nov 12;127:1–5. doi: 10.1016/j.pediatrneurol.2021.11.003

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Brain biopsies and autopsy findings. (A-D) Initial biopsy. (A) Relatively bland ischemic necrosis with cellular loss of nuclear basophilia along with perivascular inflammation. (B) Patchy areas of intraparenchymal inflammation and gliosis. (C) CD3 (brown) and CD20 (red) dual chromogen immunohistochemistry revealing predominance of CD3-positive T lymphocytes in the vascular walls and perivascular infiltrates. (D) CD163 highlights vascular and intraparenchymal histiocytes. (E-G) Second biopsy. (E) Similar findings to previous biopsy including transmural and perivascular inflammation, but also with areas of cystic change and foamy histiocytes (right upper corner). (F) CD163 highlighting histiocytes. (G) CD3 highlighting T lymphocytes. (H) Coronal section of brain at autopsy revealing confluent areas of necrosis from cortex to corpus callosum and basal ganglia, hemorrhage near previous biopsy. Microscopic images are 400× magnification. The color version of this figure is available in the online edition.