PMC6240939_01
Magnetic Resonance (MR) imaging of the head. Fat-suppressed T1-weighted gadolinium-enhanced axial scans through the skull base (a, b), and T1-weighted gadolinium-enhanced axial scans of the skull base (c, d). There is bilateral maxillary sinusitis and an infiltrative lesion of the right retropharynx (circle) around the internal carotid artery (arrow). Images were taken a on admission, b after the 1st IVCY, c before RTX treatment, and (d) 6 months after RTX treatment. (d) The sinusitis and the infiltrative lesion were markedly improved after RTX treatment
41232_2018_79_Fig1_HTML.jpg
PMC6240939_01_41232_2018_79_Fig1_HTML.jpg
Fig1
A gadolinium-enhanced MRI scan of the head showed an enhancing infiltrative lesion in the right retropharynx encasing the carotid sheath (Fig. 1a), which seemed to cause the paralysis of IX, X, XI and XII nerves. On MRI, the lesion encasing the right carotid sheath has not reduced (Fig. 1b).
Clinical course. IVCY dose and interval were 1000 mg every 3 weeks and RTX dose and interval were 600 mg every week. GC, glucocorticoid; IVCY, intravenous cyclophosphamide; RTX, rituximab; BVAS, Birmingham Vasculitis Activity Score 2008 version 3; PR3-ANCA, proteinase 3-anti-neutrophil cytoplasmic antibody; CRP, C-reactive protein
41232_2018_79_Fig2_HTML.jpg
PMC6240939_01_41232_2018_79_Fig2_HTML.jpg
Fig2
The patient was treated with prednisone (PSL) 1 mg/kg daily and IVCY 1000 mg every 3 weeks (Fig. 2).
Changes in peripheral lymphocyte count. CD4, CD4+ T cell; CD8, CD8+ T cell; CD19, CD19+ B cell
41232_2018_79_Fig3_HTML.jpg
PMC6240939_01_41232_2018_79_Fig3_HTML.jpg
Fig3
To investigate immune status, we tracked peripheral T and B cell counts after RTX administration (Fig. 3).