PMC9394442_01
Magnetic resonance (MR) imaging of central nervous system. (A) Additional MR imaging was performed as advised after initial cranial computed tomography (cCT). In FLAIR weighted MR diffuse, subcortical located, edematous alterations of cerebral tissue were present (white arrows). (B) MR imaging showed subcortical located confluent (black arrow heads) or diffuse (black arrows) signal alterations in T2 weighted image in concordant locations reported in cCT. In opposite to CT, no hint for metastases was reported. Diffuse alterations of subcortical tissue are commonly seen in T2 or FLAIR weighted images in progressive multifocal leukoencephalopathy.
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Additionally, in further work-up performed MR imaging did not show central lesions, but unspecific subcortical alterations were observed in T1- and T2-weighted images (Figures 1A, B).
Timeline of total white body cell and lymphocyte count. While total white body cell (WBC) count (light grey bars) undulated in course of disease, absolute lymphocyte (lym) count (dark grey bars) was constantly low and never reached pre-treatment levels in course of time. Relative lymphocyte count (black dots, lym %) showed a trend of decline (scattered black line, trend lym %). Missing black dots/dark gray bars represent missing laboratory parameters regarding lymphocyte counts. Arrows above chart indicate initiation of chemotherapy, time of surgery, follow-up, onset of neurologic symptoms in course of PML and hospital discharge.
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Within 6 weeks after initiation of carboplatin and paclitaxel containing chemotherapy, laboratory parameters showed no relevant pathology, besides mildly reduced leukocytes (minimum value of 3.0/nl, normal range 4.0-11.0/nl, Figure 2). By differential blood count, persistent lymphopenia of 12.6% (normal range: 20-45%, total lymphocytes: minimum of 300/nl) was observed until death (Figure 2).