case_images: PMC11043467_01
case_images: Brain and spinal MRI. Representative brain and spinal MRI in our hospital on admission, showing multiple lesions on diffusion-weighted imaging (A) and periventricular linear gadolinium enhancement (arrows) (B) on the 1st day, multiple confluent lesions in the bilateral deep white matter (C, D) on the 15th day, further enlarged lesions (E, F) with newly appeared lesions in the brainstem and cerebellum (arrowheads) (G) on the 36th day, and longitudinal spinal cord lesions (arrows) on sagittal (H) and axial (I, C3 level; J, Th5 level) T2-weighted-imaging.
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case_images: PMC11043467_01_fimmu-15-1361685-g001.jpg
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case_images: Repeated MRI showed multiple hyperintense lesions in the cerebral white matter lesions with periventricular linear enhancement ( Figures 1A, B ). On the 15th day of admission to our hospital, follow-up MRI showed that the lesions in the bilateral deep white matter were enlarged ( Figures 1C, D ). Brain MRI on the 36th day showed further enlargement of lesions, along with newly appeared lesions in the brainstem and cerebellum ( Figures 1E-G ). Spinal MRI showed extensive longitudinal spinal cord lesions ( Figure 1H-J ).
case_images: Brain biopsy samples. Kluver-Barrera staining shows that the lesion is well demarcated (A, magnified view in panel B). Glial fibrillary acid protein (C), phosphorylated neurofilament heavy chain (D), and myelin basic protein staining (E) show glial scar formation (arrowheads), spheroid neurofilaments (arrows), and decreased myelin density with phagocytosis (arrowheads), respectively. Immunohistochemical testing shows ionized calcium-binding adapter molecule-1+ (F, inset), CD68
  + (G, inset), and CD4
  + cells (H, inset) infiltrate into cerebral parenchyma. Infiltration of CD3
  + (I, inset), CD8
  + (J, inset), and CD20
  + cells (K, inset) is scarce. Scale bar = 1 mm (A), 500 mum (B, C), 100 mum (D, E), and 500 mum (F-K).
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case_images: Kluver-Barrera staining showed that the lesion was well demarcated ( Figures 2A, B ). On immunohistochemical staining, glial fibrillary acid protein, phosphorylated neurofilament heavy chain, and myelin basic protein staining showed glial scar formation, spheroid neurofilaments, and decreased myelin density with phagocytosis, respectively. ( Figures 2C-E ). As for inflammatory cells, there was marked infiltration of ionized calcium-binding adapter molecule-1+, CD68 +, and CD4 + cells ( Figures 2F-H ), whereas CD3 +, CD8 +, and CD20 + cells were scarce ( Figures 2I-K ).
case_images: Clinical course of the present case.
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case_images: Pleocytosis improved over time, as shown in  Figure 3 .