Neurosarcoidosis Presenting with Prominent Periventricular White-Matter Lesions during Steroid Treatment for Autoimmune Hepatitis.

IF 0.6 Q4 CLINICAL NEUROLOGY

Case Reports in Neurology Pub Date : 2022-08-19 eCollection Date: 2022-05-01 DOI:10.1159/000526223

Tomoya Shibahara, Fumitaka Yoshino, Mikiaki Matsuoka, Masaki Tachibana, Kuniyuki Nakamura, Tetsuro Ago, Junya Kuroda, Hiroshi Nakane

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Abstract

A 63-year-old woman under treatment of autoimmune hepatitis presented with headache, memory loss, and somnolence. Three months before admission, the patient experienced liver inflammation relapse after prednisolone (PSL) cessation. Consequently, PSL was resumed and then tapered. Cerebrospinal fluid (CSF) examination showed lymphocytic pleocytosis with remarkably reduced glucose and elevated angiotensin-converting enzyme and soluble interleukin-2 receptor levels. Magnetic resonance imaging (MRI) revealed prominent bilateral periventricular white-matter lesions, hydrocephalus, ischemic stroke with gadolinium enhancement of frontoparietal and basilar meninges on contrast-enhanced fluid-attenuated inversion recovery. Magnetic resonance angiography (MRA) showed narrowing of the bilateral middle cerebral arteries. Based on these findings, we diagnosed the patient with neurosarcoidosis. Re-increment of PSL improved the neurological symptoms, CSF findings, and abnormalities found on MRI and MRA. This case suggests that neurosarcoidosis may occur as a complication of some autoimmune diseases during immunotherapy administration.

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自身免疫性肝炎类固醇治疗期间出现显著脑室周围白质病变的神经结节病。

一名63岁女性在接受自身免疫性肝炎治疗时出现头痛、记忆丧失和嗜睡。入院前3个月，患者停服强的松龙(PSL)后肝脏炎症复发。因此，PSL恢复，然后逐渐减少。脑脊液检查显示淋巴细胞增多，血糖明显降低，血管紧张素转换酶和可溶性白介素-2受体水平升高。磁共振成像(MRI)显示突出的双侧脑室周围白质病变，脑积水，缺血性脑卒中，在对比增强的液体衰减反转恢复时，钆增强额顶叶和基底脑膜。磁共振血管造影(MRA)显示双侧大脑中动脉狭窄。基于这些发现，我们诊断患者为神经结节病。再次增加PSL可改善神经症状、脑脊液表现以及MRI和MRA上的异常。本病例提示在免疫治疗过程中，神经结节病可能是一些自身免疫性疾病的并发症。

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来源期刊

Case Reports in Neurology Medicine-Neurology (clinical)

CiteScore

1.50

自引率

0.00%

发文量

审稿时长

14 weeks

期刊介绍： This new peer-reviewed online-only journal publishes original case reports covering the entire spectrum of neurology. Clinicians and researchers are given a tool to disseminate their personal experience to a wider public as well as to review interesting cases encountered by colleagues all over the world. To complement the contributions supplementary material is welcomed. The reports are searchable according to the key words supplied by the authors; it will thus be possible to search across the entire growing collection of case reports with universally used terms, further facilitating the retrieval of specific information. Following the open access principle, the entire contents can be retrieved at no charge, guaranteeing easy access to this valuable source of anecdotal information at all times.