case_images: PMC10368104_01
case_images: On the first admission day, chest X-ray revealed patchy consolidation over right lower lung zone.
case_images: crn-2023-0015-0001-530944_F01.jpg
case_images: PMC10368104_01_crn-2023-0015-0001-530944_F01.jpg
case_images: F1
case_images: Hg, and he was in a stuporous status with prominent nuchal rigidity and bilateral rales on chest auscultation. His chest X-ray showed patchy consolidation over the right lower lung zone (shown in Fig. 1).
case_images: a, b On the 2nd admission day, the post-gadolinium T1-weighted images revealed prominent leptomeningeal enhancement at bilateral brainstem, cerebellum, and right cerebral sulci. c, d On day 30, the post-gadolinium T1-weighted images with fat saturation revealed regression of the leptomeningeal inflammation and enhancement.
case_images: crn-2023-0015-0001-530944_F02.jpg
case_images: PMC10368104_01_crn-2023-0015-0001-530944_F02.jpg
case_images: F2
case_images: On the 2nd admission day, MRI revealed one oval shape lesion in the center of splenium of corpus callosum with hyperintense signal on DWI and T2-FLAIR (a, c), low signal of ADC map (b), and no visible abnormality in the body of corpus callosum (d). On admission day 23, MRI showed extensive lesions involving the whole corpus callosum, bilateral internal capsules, and adjacent white matter with high signals on DWI (e) and T2-FLAIR (f, g). On 44th admission day, about 4 days after immunotherapy, MRI revealed slight regression of the high signals on DWI (h) and T2-FLAIR (i, j). On 79th admission day, MRI showed prominent regression of the high signals on DWI (k) and T2-FLAIR (l, m).
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case_images: PMC10368104_01_crn-2023-0015-0001-530944_F03.jpg
case_images: F3
case_images: T2-weighted fluid-attenuated inversion recovery (T2-FLAIR) (shown in Fig. 3a-d). T2-weighted fluid-attenuated inversion recovery images involving the whole corpus callosum, bilateral internal capsules, and adjacent subcortical areas were without enhancement (shown in Fig. 3e-g). The extensive and symmetric white matter changes on the The follow-up MRI on the 44th and the 79th admission day displayed continuing regression of the cytotoxic change in the corpus callosum and the white matter (shown in Fig. 3h-m).