PMC5966542_01
A timeline displaying synthetically the evolution of our case: in the red boxes, the clinical events have been reported; in the blue boxes, there is a list of the significant investigations that have been performed; and in the yellow boxes, we displayed the therapies and the relative effect.
fneur-09-00329-g001.jpg
PMC5966542_01_fneur-09-00329-g001.jpg
F1
A 75-year-old female patient was admitted to the geriatric ward in March 2016 with acute confusion, somnolence, verbal aggression, and fever (see Figure 1 for a timeline of this case report).
Brain magnetic resonance imaging (Siemens Aera 1.5 T). Axial FLAIR (1, 2), axial ADC-maps (3), axial T1 after intravenous gadolinium (4, 5), and coronal T1 after intravenous gadolinium (6). Several lesions with high T2-signal on FLAIR in the right temporal lobe, bilateral in the frontal lobe, and the callosal body without signs of restricted diffusion on the ADC-maps, compatible with vasogenic edema. Several lesions in the right temporal lobe show patchy contrast enhancement after intravenous administration of gadolinium-based contrast (4-6). None of the lesions were hemorrhagic.
fneur-09-00329-g002.jpg
PMC5966542_01_fneur-09-00329-g002.jpg
F2
Brain magnetic resonance imaging (MRI) showed spotty enhancement in the right temporal and frontal lobes with focal leptomeningeal enhancement and edema (Figure 2).
Important inflammation of the brain tissue with disseminated macrophages (B) and T-cells (C), no B-cells. Part of the T-cells is CD8-positive (D). Hematoxylin-eosin (A), immunohistochemical stain with antibodies against CD68 (B), CD3 (C), and CD8 (D). Magnification bar = 100 microm.
fneur-09-00329-g003.jpg
PMC5966542_01_fneur-09-00329-g003.jpg
F3
A brain biopsy performed to exclude a lymphoma showed signs of severe white matter destruction with many macrophages and lymphocytosis, but no malignancy, nor signs of vasculitis (Figure 3).