heroin and Encephalitis

Acute disseminated encephalomyelitis (ADEM) is an immune demyelinating central nervous system (CNS) disorder, characterized by monophasic new onset neurological symptoms including encephalopathy, combined with neuroradiological evidence of multifocal demyelination. ADEM is extremely rarely diagnosed and is much more common in children and adolescents than in adults. The aim of this study is to present an extremely rare case of ADEM in a heroin-addicted patient with a very difficult diagnostic course. The results of the magnetic resonance imaging (MRI) examination in this patient were inconclusive. Fungal abscesses or inflammatory lesions of an unclear nature were suspected especially in a patient with impaired immunodeficiency. In view of the constantly deteriorating condition of the patient with disturbed consciousness and the unclear aetiology, the lack of effective treatment, a decision was made to perform a bilateral stereotactic biopsy and aspiration of brain abnormalities in order to obtain a neuropathological specimen and begin with the causal treatment. Neuropathological examination revealed the presence of Creutzfeldt-Peters cells characteristic of ADEM. Treatment with methylprednisolone significantly improved the patient's general and neurological condition. To our knowledge, the above case is the first in the world literature in which ADEM has been confirmed by bilateral stereotaxic aspiration for the treatment of symptoms of increased intracranial pressure as a lifesaving procedure. Neuropathological confirmation allowed for the implementation of appropriate treatment, which resulted in complete recovery. Moreover, this case is interesting because ADEM was diagnosed in a patient addicted to heroin, where opportunistic inflammation of a fungal aetiology was considered in the first place.

Topics: Acute Disease; Adolescent; Adult; Child; Encephalitis; Encephalomyelitis, Acute Disseminated; Heroin; Humans; Inflammation; Magnetic Resonance Imaging

Heroin administration alters the induction of nitric oxide, a molecule known to play a critical role in immune function. Previous research has shown that these alterations can be conditioned to environmental stimuli that have been associated with drug administration. Little is known about the brain areas that mediate these effects; however, the basolateral amygdala (BLA) has been implicated in the formation of stimulus-reward associations within models of drug abuse. The present study sought to determine whether inactivation of the BLA would alter heroin's conditioned effects on the expression of inducible nitric oxide synthase (iNOS) and the proinflammatory cytokines TNF-alpha and IL-1beta in the rat. The conditioning procedure involved repeated pairing of heroin with placement into a standard conditioning chamber. To test the conditioned response, animals were returned to the previously drug-paired environment 6 days after the final conditioning session. Prior to testing, animals received intra-BLA microinfusions of a mixture of the GABA agonists muscimol and baclofen. Following removal from the chambers on test day, all animals received subcutaneous lipopolysaccharide to induce systemic expression of iNOS, TNF-alpha and IL-1beta. Analyses using real-time RT-PCR indicated that inactivation of the BLA blocked the suppressive effect of heroin-associated environmental stimuli on iNOS induction and on the expression of the proinflammatory cytokines TNF-alpha and IL-1beta in spleen and liver tissue. This study is important because it is the first to demonstrate that heroin's conditioned effects on proinflammatory mediators require the BLA. These findings may have significant implications for the treatment of heroin users.

Topics: Amygdala; Animals; Conditioning, Psychological; Encephalitis; GABA Agonists; Heroin; Heroin Dependence; Inflammation Mediators; Interleukin-1beta; Lipopolysaccharides; Liver; Male; Narcotics; Nitric Oxide; Nitric Oxide Synthase Type II; Rats; Rats, Inbred Lew; RNA, Messenger; Spleen; Tumor Necrosis Factor-alpha

Topics: Adult; Amphotericin B; Antifungal Agents; Basal Ganglia; Encephalitis; Female; Heroin; Humans; Mucormycosis; Substance Abuse, Intravenous

Topics: Adult; Brain Diseases; Encephalitis; Fungi; Heroin; Humans; Infections; Injections, Intravenous; Male; Morphine Dependence; Mycoses