PMC5577089_01
On contrast abdominal computed tomography, the liver and spleen were normal in size and shape.
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T2-weighted MRI of the spinal cord revealed partially discontinuous LETM with high-intensity lesions extending from the C4 level to the T6 level (Fig. 1A); in the axial section, the pericentral area was mainly affected (Fig. 1B, C). On T1-weighted images with gadolinium enhancement, spotty contrasted lesions were visible at the surface of the thoracic cord (T2-6, Fig. 1D). At two weeks after the administration of these therapies, MRI revealed a reduction in the size of the cervical and thoracic cord lesions (Fig. 1E, compared with Fig. 1A) but no remarkable change in the optic nerve lesion.
The patient's clinical course. Serum HBsAg was negative, and HBV-DNA was present at 2.6 log copies/mL before chemotherapy. Entecavir (ETV) was used during R-THP-COP chemotherapy and the subsequent 14 months. Serum HBV-DNA levels remained undetectable, and serum gammaglobulin levels were within the normal range. ETV was discontinued at 14 months after the end of chemotherapy. However, serum HBV-DNA became positive at 24 months and increased to 3.3 log copies/mL at 27 months. In addition, serum HBsAg also reverted. After restarting ETV at 28 months, serum HBV-DNA and HBsAg immediately turned negative. Anti-HBs became positive for the first time at 31 months and remained positive at 46 months, whereas ETV was re-discontinued at 36 months.
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On orbital MRI, short T1 inversion recovery images of the coronal section revealed a ring-shaped, high-intense perineural lesion of the right optic nerve (Fig. 2A). Axial T2-weighted MRI revealed a "tram-track sign" on the right optic nerve (Fig. 2B).
Details of the clinical course from 24 to 29 months after the end of chemotherapy. Serum HBV-DNA became positive at 24 months and increased to 3.3 log copies/mL at 27 months. HBsAg, HBeAg and HBcrAg reverted at the same time. Two weeks later, laboratory data showed a further increase in the serum HBV-DNA levels and reconversion of HBeAg without elevation of serum ALT levels. The patient started taking entecavir (ETV) again at 28 months. After restarting ETV, serum HBV-DNA, HBsAg, HBeAg and HBcrAg immediately turned negative.
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Flash VEP revealed two bottoms (P1 and P2) and a prolonged P100 latency (P2, 130.6 ms) on right eye stimulation (Fig. 3A) in comparison to the P100 latency (P1, 120.9 ms) on left eye stimulation (Fig. 3B). A follow-up flash VEP examination that was performed 1 year later showed an improvement in the P100 latency on the right optic nerve (right, 120.3 ms; left, 121.8 ms) (Fig. 3C, D).