PMC5399832_01
Brain MRI displaying PML features in a PCV patient treated with hydroxyurea. Axial and coronal T1-weighted sections displaying multifocal and confluent supra- and infratentorial lesions without contrast enhancement (arrows). There are also supratentorial punctate lesions (indicated by an arrow head). To the right T2-weigthed section displaying lesions in the right cerebellar hemisphere (arrow). No restricted diffusion
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Fig1
On diffusion-weighted imaging (DWI) lesions were hyperintense but without restricted diffusion as the apparent diffusion coefficients (ADC) were not decreased in the area (Fig. 1).
Brain MRI on day 38 of admission in a male with underlying PCV who developed PML. Axial T2-weighted sections display increased number of widespread and confluent supra- and infratentorial lesions. There were several "ring-shaped" lesions with hyperintensive periphery on DWI, increased central signal and isointense periphery on ADC. On T2-weighted images the lesions were globally hyperintense
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Fig2
A second MRI of the brain three weeks after admission displayed an increased number of widespread supra- and infratentorial lesions (Fig. 2).
Histopathological findings. On coronal sections of the brain the white matter of the right temporal and frontal lobes was soft and its color grey-pink. Similar changes were also seen in the right cerebellar hemisphere (arrow head). On microscopy, widespread white matter lesions in those regions with destruction of myelin and the presence of large astrocytes and enlarged oligodendrocytes were evident. Some astrocytes had a bizarre appearance (arrow on picture below). Many similarly small white matter lesions were also present in the left cerebral hemisphere and the brainstem
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Fig3
Histopathological analysis of the brain confirmed progressive multifocal leukoencephalopathy (PML) (Fig. 3).