PMC7417347_01
Lesions (arrowed) on brain coronary MRI images before (a-c) and after (d-f) antiviral treatment showing obviously manifested shrinkage after antiviral treatment. T2-weighted: Lesions on the medulla oblongata (a,d). T2-FLAIR-weighted: Lesions on the right arm of medulla oblongata (b,e). DWI: Lesions on right side of the right corpora quadrigemina, right side wall of the fourth ventricle and right side of the medulla oblongata (c,f). DWI, Diffusion-weighted MRI.
fimmu-11-01634-g0001.jpg
PMC7417347_01_fimmu-11-01634-g0001.jpg
F1
A blood test was positive for AQP4 antibodies and brain MRI found high-signal lesions (Figures 1a-c). Further, high-signals on the brain MRI were significantly reduced (Figures 1d-f).
Changes of rectal ulcer on colonoscopy before (a) and after (b) antiviral treatment.
fimmu-11-01634-g0002.jpg
PMC7417347_01_fimmu-11-01634-g0002.jpg
F2
However, colonoscopy revealed a large ulcer-like lesion at 10 cm above the anus and a large amount of feces and dark red bloody fluid (Figure 2a). After 4 weeks of antiviral therapy, the colonoscopy revealed a smooth intestinal wall at the original lesion (Figure 2b).
CMV HE staining and IHC of the biopsy specimen from the edge of the rectal ulcer lesions before (a,b) and after (d,e) antiviral therapy. Detection of CMV gene copies in CSF by NGS. Magnification x 400 (c). HE, Hematoxylin and eosin; IHC, immunohistochemical; NGS, next-generation sequencing.
fimmu-11-01634-g0003.jpg
PMC7417347_01_fimmu-11-01634-g0003.jpg
F3
These results confirmed the presence of CMV infection (Figures 3a,b). In addition, CSF pathogen gene sequencing also detected CMV gene copies on day 25 post-admission (Figure 3c) and serum AQP4-IgG was still positive. After 3 weeks of antiviral therapy, her lower gastrointestinal bleeding stopped, and the CMV staining of rectal biopsies (Figures 3d,e), CSF CMV gene sequencing, and serum AQP4 all became negative.