PMC5779784_01
MRI scans of case 1 (6 months before admission) showed hyperintensity lesions in the spinal cord from C1 to C7 on T2 sequence. MRI = magnetic resonance imaging.
medi-97-e9676-g001.jpg
PMC5779784_01_medi-97-e9676-g001.jpg
F1
The magnetic resonance imaging (MRI) scan of the cervical spine (6 months before admission) revealed cervical spinal cord lesions without gadolinium enhancement (Fig. 1). The serum anti-AQP4-Ab was strongly positive, and the Immunoglobulin G (IgG) oligoclonal bands were negative both in the serum and in the cerebrospinal fluid (CSF).
A-F, Brain MRI scans of case 1 showed multiple hyperintensity lesions (A-D) in the right thalamus and pons on the T2 and DWI sequences. High-intensity lesions were also found in the left basal ganglia on the FLAIR sequence (E) as well as in corona radiate and corpus callosum on the DWI sequence (F). DWI = diffusion-weighted imaging, FLAIR = fluid-attenuated inversion recovery, MRI = magnetic resonance imaging.
medi-97-e9676-g002.jpg
PMC5779784_01_medi-97-e9676-g002.jpg
F2
T2-weighted (T2W) imaging (Fig. 2). The second MRI scan of cervical and thoracic spinal cord after admission to the hospital revealed hyperintensity lesions extending from
A-D, MRI scans of case 1 before treatment showed hyperintensity lesions in the spinal cord from C3 to T8 on T2 sequence (A-C). Chest CT scan showed bronchitis and pneumonia in both sides, bronchiectasis in the left upper lobe and multiple calcifications of in both upper lobe (D). CT = computed tomography, MRI = magnetic resonance imaging.
medi-97-e9676-g003.jpg
PMC5779784_01_medi-97-e9676-g003.jpg
F3
T1-weighted (T1W) image, and FLAIR image (Fig. 3A-C). Chest CT during hospitalization showed left lung upper lobe bronchiectasis and multiple calcifications of upper lobe in both sides (Fig. 3D).
A-B, MRI scan of case 1 12 months after treatment showed hyperintensity signal from C6 to T8 levels on T2-weighed sequence. The lesion was significantly reduced compared with that before treatments, spinal cord slightly atrophy (A-B). MRI = magnetic resonance imaging.
medi-97-e9676-g004.jpg
PMC5779784_01_medi-97-e9676-g004.jpg
F4
The patient was treated with methylprednisolone of 500 mg for 3 days, afterwards, the dose of methylprednisolone was decreased to half every 3 days, meanwhile she also received gamma globulin and anti-tuberculosis drugs (isonicotinyl hydrazide 0.3 g/d, rifampin 0.45 g/d, pyrazinamide 1 g/d, and ethambutol 1 g/d). The patient discharged from hospital after 1 months' treatment. The EDSS was decreased to 0 at the time point of follow up 12 months later. The spinal cord MRI showed the lesion size in the cervical and thoracic spine were significantly reduced (Fig. 4).
PMC5779784_02
A-D, MRI scan of case 2 showed hyperintensity signal from C3 to T11 on T2-weighed images (A-C). Lung CT scan showed tuberculosis with cavitation in the left upper lobe (D). CT = computed tomography, MRI = magnetic resonance imaging.
medi-97-e9676-g005.jpg
PMC5779784_02_medi-97-e9676-g005.jpg
F5
T2W and FLAIR images and hypointense signal on T1W images (Fig. 5A-C). The MRI of the thoracic spinal cord revealed altered medullary signal intensity from T2W images (Fig. 5B). The chest CT showed left upper lobe tuberculosis with cavitation (Fig. 5D). CSF routine test showed increased protein levels (0.48 g/L, normal range from 0.15 to 0.45 g/L). The CSF cell numbers were within the normal range (4 x 106/L). The anti-AQP4-Ab was negative both in the serum and in the CSF of the patient. Tuberculosis mycobacterium antibody was negative both in serum and CSF.