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case_images: Images of lymphoma lesions at onset (A) PET-CT reveals numerous lesions. (B) MRI (contrast enhanced T1WI) shows meningeal involvement (arrow).
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case_images: Meningeal lesions were identified using brain MRI (Figure 1).
case_images: Clinical course of the patient. Rx=modified CODOX-M/IVAC regimen, comprising cyclophosphamide, vincristine, doxorubicin, methotrexate, ifosfamide, etoposide, and cytarabine. MTX was administered systemically at a high dose (3 g/m2/dose) with folinic acid rescue as well as intrathecally (15 mg/dose). MMT=Manual muscle testing. SAMe=S-adenocylmethionine. As shown, MMT improved after the administration of SAMe and methionine.
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case_images: As illustrated in Figure 2, on day 82 of treatment, she developed fever with a temperature of approximately 38oC and reported muscle weakness as well as sensory disturbances in her lower extremities.
case_images: MRI (T2WI) of the thoracic spinal cord (Th 9 level) reveals a high-signal area at the dorsal column at the onset of neurological symptoms (left; arrow) and the disappearance of the lesion coexisted with atrophy of the cord approximately 45 months later (right; arrow).
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case_images: A spine MRI (T2WI) showed a hyper-intensity signal around the area, preferentially involving the dorsal columns (Figure 3).
case_images: NCS results show that decreased but preserved bilateral peroneal nerve amplitude of CMAP at the onset (upper) and they recovered to the normal level approximately three years later (lower).
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case_images: Nerve conduction study (NCS) revealed that decreased but preserved bilateral peroneal nerve amplitude of compound muscle action potential (CMAP) at the onset (Figure 4).