case_images: PMC11149418_01
case_images: Magnetic resonance of the spine and brachial plexus. Sagittal (A) T2 shows extensive intramedullary lesion with high signal intensity and cord swelling from C2-T3. Axial T2 (B) and T1 FS (C) after gadolinium show the most evident increase in signal and swelling on the right side of the medulla and unilateral contrast enhancement (long arrows), suggesting a spinal inflammatory process. Note the enlargement of the root ganglion on the right side (short arrow). (D) Coronal STIR MIP is the irregular and extensive thickening and edema of C7, C8, and T1 roots and inferior and middle trunks of the right brachial plexus (yellow arrows).
case_images: fmed-11-1400423-g001.jpg
case_images: PMC11149418_01_fmed-11-1400423-g001.jpg
case_images: fig1
case_images: The images obtained in the pre- and post-treatment of the case are shown in Figures 1A-D, 2A-C.
case_images: A magnetic resonance of the right arm coronal oblique T2 SPACE (A) and T1 FS after contrast (B). Diffuse and lobulated ulnar and medial cutaneous nerve thickening and neural enhancement (long arrows) and large intraneural cavitations (short black arrows). Axial T2 FS (C), the large cavitation (short black arrow), and neural thickening. Note the multiple fascicule enlargement at the non-cavitated portion (yellow arrows).
case_images: fmed-11-1400423-g002.jpg
case_images: PMC11149418_01_fmed-11-1400423-g002.jpg
case_images: fig2
case_images: The images obtained in the pre- and post-treatment of the case are shown in Figures 1A-D, 2A-C.
case_images: A microscopic image in hematoxylin and eosin, 100x. Presence of marked mononuclear inflammatory infiltrates around the vessels, fascicles, and in the fibroadipose tissue. The inflammatory infiltrate is also present in the perineurium and endoneurium, which shows outlines of granulomas. The circle highlights a giant Langhans cell. B Wade, 1,000x. Presence of moderate to marked mononuclear inflammatory infiltrate in the endoneurium and prominent bacilli (circle).
case_images: fmed-11-1400423-g003.jpg
case_images: PMC11149418_01_fmed-11-1400423-g003.jpg
case_images: fig3
case_images: These changes included the presence of a mononuclear inflammatory infiltrate (with foamy macrophages) in the epineurium, perineurium, and endoneurium; fibrosis in the epineurium and endoneurium; the absence of myelin fibers (observed in semithin sections); and the presence of acid-fast bacilli in foamy macrophages (Wade-Fite stain, 1+/4+) (Figure 3). The histopathological images are shown in Figures 3A,B.
case_images: Magnetic resonance of the cervical spine shows that intramedullary changes are no longer observed on T2 (A,B) and T1FS after gadolinium (C). Note the reduced size and enhancement of the right root ganglion. (D) Coronal STIR MIP with improvement in signal changes and size of cervical roots and brachial plexus on the right (yellow arrows).
case_images: fmed-11-1400423-g004.jpg
case_images: PMC11149418_01_fmed-11-1400423-g004.jpg
case_images: fig4
case_images: The ulnar nerve in the rest of the forearm had normal thickness and signal intensity in the most recent examinations (Figures 4A-D).