Endothelial cell activation in muscle biopsy samples is related to clinical severity in human cerebral malaria.

To test the hypothesis of vascular sequestration of parasitized erythrocytes in Plasmodium falciparum malaria in vivo, a pathologic and immunohistochemical study was done of the microvasculature of skeletal muscle biopsy samples from P. falciparum malaria patients at different stages of severity. Parasitized red blood cells sequestered in the skeletal muscle vessels were observed in samples from necropsies but were never demonstrated in biopsy specimens. Vascular cell adhesion molecule-1 and E-selectin expression was consistent only in specimens from cerebral malaria patients. Samples from such patients had strong staining of the constitutive endothelial adhesion molecules tested. The staining intensity gradually decreased in samples from persons with milder forms of the disease. Four of 13 patients with severe malaria had aggregates of red blood cells, occasionally parasitized inside the muscle fibers. These data suggest that skeletal muscle biopsy could be a useful model for the study of the pathogenesis of malaria in vivo.

Giant-cell arteritis presenting with ipsilateral hemiplegia and lateral medullary syndrome.

We describe the clinical and anatomopathological findings in an 85-year-old male presenting with a lateral medullary syndrome and ipsilateral hemiplegia (Opalski's syndrome) due to giant-cell arteritis of the vertebral artery. Other common associated symptoms of the disease were absent, and the erythrocyte sedimentation rate was only of 30 mm/h. This case emphasizes that limited intracranial giant-cell arteritis may present rarely as a stroke.