PMC9582131_01
Disease timeline. In this timeline are displayed clinical (shown in blue) and CSF (in purple) changes in relation to antibiotic course (in red) and steroid therapy (in green). On the bottom, MRI T1-weighted imaging with gadolinium contrast performed after 18 days from clinical onset (A) demonstrated bilateral pathologically relevant gadolinium enhancement in VII and VIII cranial nerves' intrameatal tract bilaterally (red arrows), which was not present in the first MRI (B). CSF, cerebrospinal fluid.
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A 27-year-old Italian woman living in London who returned to Italy recently suddenly presented fever, sore throat, headache, nausea, vomiting, and transient binocular diplopia (for the disease timeline see  Figure 1 ).
CSF IgGOB pattern modification. When the first lumbar puncture was performed at the beginning of the infection, no oligoclonal bands in CSF or serum were found (pattern I) (A), while after 11 days of antibiotic therapy, there was presence of a few CSF-restricted oligoclonal bands (triangle) together with mirror serum-CSF bands (diamond) (pattern III) (B). CSF, cerebrospinal fluid; IgGOB, IgG oligoclonal bands.
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Interestingly, oligoclonal IgG bands (pattern III: oligoclonal IgG in CSF with additional identical bands in CSF and serum) were present ( Figure 2 ).