PMC9939766_01
Blood lactate curve and treatment of the patient. The blue line represents the blood lactate levels of the patient after admission, and the straight lines with different colors represent different therapeutic drugs. IVIG, intravenous immunoglobulin.
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F1
Laboratory tests performed on admission showed the following: white blood cell count, 19.21 x 109/L (normal range, 4-9 x 109/L); procalcitonin, 0.74 ng/ml (normal range, <0.15 ng/ml); and blood lactate, 4.2 mmol/L (normal range, 0.5-1.7 mmol/L) (Figure 1).
Serum anti-AQP4-IgG levels in the patient. The serum samples of the patient were examined using cell-based assays, which used HEK293 cells transfected with human AQP4. The anti-AQP4 antibody test is positive (A), and the antibody titer is 1:10 (initial titer, 1:1). After 3 days, the anti-AQP4 antibody test is still positive, with an antibody titer of 1:10 (D). (B,E) are positive controls, while (C,F) are negative controls. Cells stained green are positive for the anti-AQP4 antibody; unstained cells are negative for this antibody. Scale bar: 25 mum. AQP4, aquaporin-4.
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F2
CSF examination revealed a lactate level of 3.5 mmol/L (normal range, 0.999-2.775 mmol/L); the results of CSF cytology, biochemistry, and culture examinations were all normal. Cell-based assays were performed to assess the serum levels of anti-AQP4-IgG, anti-myelin oligodendrocyte glycoprotein, anti-glial fibrillary acidic protein, and anti-myelin basic protein antibodies: only the serum anti-AQP4-IgG test was positive (Figure 2), with a titer of 1:10 (initial titer, 1:1).
Cranial MRI of the patient. Cranial MRI shows bilateral symmetrical lesions of abnormal signal intensity around the third ventricle, pons, dorsal medulla oblongata, and in the gray matter around the dorsal aqueduct. Axial T2-FLAIR images (A-D, white frames) and a sagittal T2-weighted image (E, red frames) show the lesions. MRI, magnetic resonance imaging; FLAIR, fluid attenuated inversion recovery.
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F3
Cranial magnetic resonance imaging (MRI) revealed bilateral symmetrical lesions of abnormal signal intensity around the third ventricle, pons, dorsal medulla oblongata, and in the gray matter around the dorsal aqueduct on T2-weighted images and fluid attenuated inversion recovery (FLAIR) images (Figure 3).