PMC7218968_01
(a) The patient presented with a diffuse, nonblanching maculopapular rash with scattered petechiae and purpura involving the trunk, upper and lower extremities, palms, and soles. (b) Area of petechiae on the arm where a blood pressure cuff was used.
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Her exam was notable for impaired consciousness, hypotonia, periorbital edema, and a petechial, nonblanching rash over the all extremities, her trunk, and her palms and soles (Figure 1).
(a, b) Axial diffusion-weighted images demonstrate multifocal areas of gyriform diffusion restriction involving the cortex. Additional scattered foci of diffusion restriction within the periventricular white matter give the appearance of a "starry sky." (c) A coronal post contrast T1 image demonstrates diffuse leptomeningeal enhancement. (d) An axial post contrast T2 FLAIR image also demonstrates diffuse leptomeningeal enhancement.
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MRI of the brain revealed diffuse abnormal leptomeningeal enhancement with numerous focal areas of restricted diffusion scattered throughout the gray and white matter of both cerebral hemispheres (Figure 2).