PMC9732423_01
Brain magnetic resonance imaging (A) showed cerebrospinal meninges (left, red arrow) and auditory nerve thickening (right, red arrow). Positron emission tomography/computerized tomography in transverse section (B) and longitudinal section (C) showed multiple cerebrospinal meninges with increased 18F-flurodeoxyglucose metabolism (red arrows).
fonc-12-1027585-g001.jpg
PMC9732423_01_fonc-12-1027585-g001.jpg
f1
Brain magnetic resonance imaging (MRI) showed cerebrospinal meninges and auditory nerve thickening ( Figure 1A ). Figures 1B, C ). Further examination showed she had no abnormalities in the hemogram, M-protein level, renal function, LDH level, and beta2-MG level.
Cerebrospinal fluid smear showed the presence of abnormal plasma cells (red arrows) before (A) and after (B) salvage therapy.
fonc-12-1027585-g002.jpg
PMC9732423_01_fonc-12-1027585-g002.jpg
f2
However, her cerebrospinal fluid (CSF) was positive for plasma cells ( Figure 2A ), and a lumbar puncture showed the CSF had a protein content of 213.8 mg/dL (normal range: 20-40), glucose of 50 mg/dL (normal range: 50-60), and 42x106 nucleated cells/L (normal range: 0-8x106). Furthermore, this treatment reduced the CSF plasmacytosis by more than 80% ( Figure 2B ).
Timeline of the patient's diagnosis and treatments.
fonc-12-1027585-g003.jpg
PMC9732423_01_fonc-12-1027585-g003.jpg
f3
The timeline of the patient is summarized in  Figure 3 .