PMC6794173_01
Changes in brain magnetic resonance imaging (MRI) over time. Fluid-attenuated inversion recovery (FLAIR) scans at first admission (A) and two months (B), three months (C), and six months (D) after the first admission. (A) shows nonspecific changes. (B) shows focal lesions in the white matter of the bilateral frontal and temporal lobes. (C) shows that the lesions in the white matter on FLAIR grew. (D) shows that the lesions gradually disappeared, and no new lesions developed.
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Nonspecific lesions were seen on fluid-attenuated inversion recovery (FLAIR) images (Fig. 1A). Brain MRI revealed focal lesions in the white matter of the bilateral frontal and temporal lobes (Fig. 1B). Follow-up MRI performed one month after readmission showed enlargement of some lesions and the appearance of new lesions (Fig. 1C). Two months after discharge, JCV DNA in CSF was negative, and MRI findings showed slight improvement (Fig. 1D).
Summary of the clinical course. Methotrexate and infliximab were discontinued, and antifungal therapy was initiated at readmission. The patient symptoms improved over 10 weeks, and there was no recurrence >24 weeks after the first admission.
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The clinical course is summarized in Fig. 2.