Vasculitis with predominantly leptomeningeal involvement in an AIDS patient

A case of a 45-year-old female AIDS patient with an unusual type of vasculitis is presented. Clinically, she exhibited hemiparesis, hemianopsia, oculomotor abnormalities, grand mal seizures, and multiple cerebral ischemic lesions. Neuropathologic examination revealed a necrotizing, lymphocytic vasculitis predominantly involving the leptomeningeal spaces in various anatomical locations. The vasculitis was most probably due to the primary effect of HIV-1, as no other possible pathogenetic agent was isolated.