PMC4107492_01
Brain magnetic resonance imaging (panels a and b) and light microscopy findings on brain specimens from autopsy (panels c and d). Panel a. Axial T2-weighted magnetic resonance image (MRI): multifocal T2 hyperintense subcortical lesions with u-fiber involvement and no mass effect. Panel b. T1-weighted MRI with Gadolinium: lesions are hypointense. The frontal lesion shows very little peripheral enhancement. Panel c. Brain section-hematoxylin-eosin x 400: white matter showing two clusters of blue, oval shaped microsporidia surrounded by macrophages. Panel d. Brain section-hematoxylin-eosin x 400: microsporidia with the characteristic extruded polar tube.
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F1
A brain CT-Scan and a magnetic resonance imaging (MRI) revealed multifocal coalescent lesions with no mass effect and very little or no enhancement in the white matter of upper left parietal and left occipital, right temporal and frontal lobes with cerebral atrophy, suggestive of progressive multifocal leukoencephalopathy (PML) (Figure  1, panels a and b). Intracellular clusters of microsporidial spores were found, some of them with tubular extensions (Figure  1 panels c and d).