PMC7298109_01
Imaging examination. (A) The head CT shows a low-density lesion in the white matter area. (B) The DWI sequence of the head MRI suggests a high signal shadow in the white matter and gray matter junction area, especially on the left side, which is characteristic of the inclusion disease in the nuclei of the neurons. (C) The T2 Flair sequence of the skull MRI also shows abnormal signals in the white matter region of the brain. (D) No significant intracranial aortic stenosis or occlusion changes are observed in the head MRA.
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F1
An emergency computed tomography (CT) scan of her brain showed leukoaraiosis and senile brain changes (Figure 1A). The MRI (Figures 1B,C) and magnetic resonance angiography (MRA) (Figure 1D) of the head showed improvement. The DWI (Figure 1B) was suspicious for "neuronal intranuclear inclusion disease," and a skin biopsy of the right thigh was performed.
Pathological examination. (A) Anti-P62 immunohistochemical staining. Visible inclusion bodies in the nucleus of some skin sweat gland cells (x 400). (B) Anti-P62 immunohistochemical staining. Visible inclusion bodies in the nucleus of some fat cells (x 400). (C) Electron microscopy shows a circular inclusion body structure in the nucleus of a sweat gland (x 15,000). (D) Hematoxylin-eosin staining shows eosinophilic inclusion bodies in some sweat gland cells. The inset on the upper right shows amplification of one of the nuclei (x 400).
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F2
The pathology report of the skin biopsy (Figure 2) showed eosinophilic inclusions in the nuclei of the sweat gland cells and fat cells of the skin.