case_images: PMC5966542_01
case_images: A timeline displaying synthetically the evolution of our case: in the red boxes, the clinical events have been reported; in the blue boxes, there is a list of the significant investigations that have been performed; and in the yellow boxes, we displayed the therapies and the relative effect.
case_images: fneur-09-00329-g001.jpg
case_images: PMC5966542_01_fneur-09-00329-g001.jpg
case_images: F1
case_images: A 75-year-old female patient was admitted to the geriatric ward in March 2016 with acute confusion, somnolence, verbal aggression, and fever (see Figure 1 for a timeline of this case report).
case_images: Brain magnetic resonance imaging (Siemens Aera 1.5 T). Axial FLAIR (1, 2), axial ADC-maps (3), axial T1 after intravenous gadolinium (4, 5), and coronal T1 after intravenous gadolinium (6). Several lesions with high T2-signal on FLAIR in the right temporal lobe, bilateral in the frontal lobe, and the callosal body without signs of restricted diffusion on the ADC-maps, compatible with vasogenic edema. Several lesions in the right temporal lobe show patchy contrast enhancement after intravenous administration of gadolinium-based contrast (4-6). None of the lesions were hemorrhagic.
case_images: fneur-09-00329-g002.jpg
case_images: PMC5966542_01_fneur-09-00329-g002.jpg
case_images: F2
case_images: Brain magnetic resonance imaging (MRI) showed spotty enhancement in the right temporal and frontal lobes with focal leptomeningeal enhancement and edema (Figure 2).
case_images: Important inflammation of the brain tissue with disseminated macrophages (B) and T-cells (C), no B-cells. Part of the T-cells is CD8-positive (D). Hematoxylin-eosin (A), immunohistochemical stain with antibodies against CD68 (B), CD3 (C), and CD8 (D). Magnification bar = 100 microm.
case_images: fneur-09-00329-g003.jpg
case_images: PMC5966542_01_fneur-09-00329-g003.jpg
case_images: F3
case_images: A brain biopsy performed to exclude a lymphoma showed signs of severe white matter destruction with many macrophages and lymphocytosis, but no malignancy, nor signs of vasculitis (Figure 3).