PMC8320724_01
MRI findings of CM in our patients. (A) Abnormally enlarged perivascular spaces in the basal ganglia bilaterally (white arrows) in Axial T2-weighted images (WI); (B) Choroid plexus (white arrows) at the admission in Axial gadolinium-enhanced T1-WI; (C) Bilateral choroid plexitis (white arrows) after ten days of antifungal therapy, in Axial gadolinium-enhanced T1-WI. (D) Absence of choroid plexitis after steroids therapy in Axial enhanced T1-WI.
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Brain magnetic resonance imaging (MRI) did not exhibit lesions or evidence suggestive of high intracranial pressure, except for enlarged perivascular spaces in the basal ganglia ( Figure 1 ). To support the inflammatory hypothesis, as reported by Hammoud et al., brain MRI performed at this stage was conducted which demonstrated hypertrophic choroid plexus (choroid plexitis) ( Figure 1 ). The brain MRI performed at the end of steroid therapy also exhibited resolution of previously reported abnormalities ( Figure 1 ). The patient was then discharged from the hospital after two weeks from the initiation of steroids therapy, with resolution of diplopia with no other neurological deficits.
Graphical representation of CM therapy in our patient.
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He continued trimethoprim/sulfamethoxazole prophylaxis (160/800 mg daily, three times a week) plus maintenance fluconazole (800 mg) and continuation of weekly administration of SC immunoglobulin infusions ( Figure 2 ).