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Axial T2-FLAIR MRI image demonstrating subcortical white matter hyperintensities most prominent within the frontal lobes. Image is courtesy of Dr. Jane Congeni.
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T2 FLAIR sequence, mostly in the frontal lobes and scattered throughout the subcortical white matter (Figure 1). The lesions remained unchanged on repeat MRI at 2 weeks and again at 4 months following presentation, suggesting that these lesions may be consistent with glial scars without acute inflammation of the brain.
EBV copies remained at nearly 1000 per mL in peripheral blood after a 2-week treatment combination of IVIG and antivirals. EBV copies were reduced drastically with the first dose of rituximab and became undetectable following the second dose.
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Five days after the second rituximab infusion CD19+ and CD20+ lymphocytes and EBV PCR were found to be absent in the blood and remained absent for 5 months, at which time hematopoietic stem cell transplant (HSCT) was performed (Table 1 and Figure 2).