PMC5548686_01
Magnetic resonance imaging (fluid-attenuated inversion recovery) at the time of the multiple sclerosis diagnosis shows several hyperintense lesions in the cerebral white matter and cerebellum (white arrows).
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At that time, magnetic resonance imaging (fluid-attenuated inversion recovery) showed several hyperintense lesions in the cerebral white matter, cerebellum, brain stem and spinal cord (Fig. 1), and oligoclonal bands were positive in her cerebrospinal fluid.
Abdominal computed tomography on admission shows hepatic atrophy and peripheral edema of the portal trunk and gallbladder.
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Contrast-enhanced computed tomography showed hepatic atrophy and peripheral edema of the portal trunk and gallbladder, without remarkable changes in the brain (Fig. 2).
Clinical course of the patient. ALT: alanine transaminase, CHDF: continuous hemodiafiltration, PE: plasma exchange, PT: prothrombin time activity, T-Bil: total bilirubin
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She died from liver failure on hospital day 6 (Fig. 3).
Autopsy findings of the brain. A: Grossly, there are multiple patchy lesions in the cerebral white matter (white arrowheads). B: Kluver-Barrera's staining shows well-demarcated myelin pallor in the cerebral white matter (white arrowheads). C: Histologically, the demyelinating lesions in the cerebral white matter contain proliferating reactive astrocytes (black arrowheads) and infiltration of lymphocytes and histiocytes in the peripheral vessels (black arrow) (Hematoxylin and Eosin staining). D: Glial fibrillary acidic protein (GFAP) -positive cell numbers are increased in the lesions with mild gliosis (GFAP antibody staining). Scale bar, 100 mum.
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In the macroscopic findings, we noted multiple patchy lesions in the cerebral white matter, cerebellum, brain stem and spinal cord (Fig. 4A). In the microscopic findings, we noted extensive lesions of myelin pallor in the cerebral white matter, cerebellum, brain stem and spinal cord, with both clear and unclear boundaries in Kluver-Barrera's staining, indicating demyelinating lesions (Fig. 4B). These demyelinating lesions contained proliferation of reactive astrocytes and infiltration of lymphocytes and histiocytes in the peripheral vessels (Fig. 4C). Immunohistochemically, glial fibrillary acidic protein (GFAP) staining revealed only mild gliosis (Fig. 4D).
Autopsy findings of the liver. A: The macroscopic appearance of the liver shows remarkable atrophy. B: A histopathological examination of the liver shows massive necrotic lesions in the liver without periportal fibrosis or lymphocyte infiltration (Hematoxylin and Eosin staining). Scale bar, 500 mum.
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Grossly, the liver was remarkably atrophic, and the weight was 740 g (Fig. 5A). Histologically, there were massive necrotic lesions in the liver without periportal fibrosis or lymphocyte infiltration (Fig. 5B).