case_images: PMC10968895_01
case_images: Magnetic resonance images of reported case. (A) Midsagittal plane, (D) transverse plane and (E) transverse plane are T2-weighted images. (B) Midsagittal plane, (F) transverse plane and (G) transverse plane are T1-weighted images. (C) Midsagittal plane, (H) transverse plane and (I) transverse plane are T1-weighted post-contrast images. (D,F,H) The level of T8 (red line). (E,G,I) The level of L3-4 intervertebral disc (green line).
case_images: fvets-11-1303084-g001.jpg
case_images: PMC10968895_01_fvets-11-1303084-g001.jpg
case_images: fig1
case_images: T1W, dorsal STIR, transverse T2W, transverse T1W, transverse T2*, transverse post-contrast T1W, sagittal post-contrast 3D T1W and transverse post-contrast T1W with fat saturation. The MR images revealed no sign of intervertebral disc disease, nucleus pulposus signal of all imaged intervertebral discs being T2 hyperintense. There was a patchy ill-defined intramedullary lesion of variable extent, but seen from T1 to L4 (Figure 1).
case_images: Microscopic images, hematoxylin and eosin. (A) Transversal section of the thoracic spinal cord at the level of T9 with bilateral fairly symmetrical necrotizing and lymphohistiocytic leukomyelitis of the dorsal, lateral, and ventral funiculi with a vascular pattern affecting the ventral spinal artery and dorsolateral arteries, and their main branches (vertical and sulcal), degenerative changes of the myelin sheaths and axons in the lateral funiculi, and non-necrotic gray matter with lymphocytic perivascular cuffing and multifocal lymphohistiocytic infiltration within the leptomeninges. Scale bar = 500 mum. (B) Lymphocytic perivascular cuffing in the grey matter adjacent to the central canal. Scale bar = 50 mum. (C) Detail of the dorsal and lateral funiculi, necrotizing and lymphohistiocytic leukomyelitis with presence of many gitter cells. Scale bar = 20 mum. (D) Detail of the lateral funiculi, myelin sheaths vacuolation with marked swelling of axons (spheroids). Scale bar = 20 mum. (E) Transversal section of the thoracic spinal cord at the level of T3. Scale bar = 500 mum. (F) Transversal section of the thoracic spinal cord at the level of T6. Scale bar = 500 mum. (G) Transversal section of the thoracic spinal cord at the level of T12. Scale bar = 500 mum. (H) Transversal section of the thoracic spinal cord at the level of L3/4. Scale bar = 500 mum. The craniocaudal extent of the lesions, with preferential involvement of the dorsal funiculi at the lumbar segment in H, is appreciated in E-H.
case_images: fvets-11-1303084-g002.jpg
case_images: PMC10968895_01_fvets-11-1303084-g002.jpg
case_images: fig2
case_images: T3-L3 spinal cord sections confirmed an inflammatory process mostly restricted to spinal cord white matter and leptomeninges (Figure 2). This process was characterized by a bilateral and fairly symmetrical, severe necrotizing leukoencephalitis (Figure 2A) with perivascular lymphocytic cuffs (Figure 2B). Numerous axons were enlarged (spheroids), and there were empty myelin sheaths, and myelin breakdown accompanied by large macrophages, gitter cells found within dilated myelin sheaths that contain axonal debris, all admixed with a few lymphocytes and neutrophils (Figures 2C,D). T9-T12, visualization of the meninges confirmed large lymphocytic infiltrates surrounding both the ventral and the dorsal spinal arteries as well as their vascular tree along the leptomeninges (Figures 2A,G,H). The central branch at the ventral median fissure was populated by a dense population of lymphocytes with a few monocytes and neutrophils that upon entry into the gray matter expanded a few Virchow-Robin spaces surrounding the central canal of the ventral horns. T9 (Figures 2A,E,F), spinal cord lateral funiculi multifocally showed evidence of axonal tract degeneration in the form of axonal spheroids and digestion chambers with reactive astrocytes and capillaries (Figures 2E,F). The inflammatory process in those rostral spinal cord sections was minimal and restricted to a few immune cells infiltrating some perivascular spaces.