Tuberculous myelitis diagnosed by elevated adenosine deaminase activity in cerebrospinal fluid

Suda, Satoshi; Ueda, Masayuki; Komaba, Yuichi; Yamazaki, Mineo; Katsumata, T; Katayama, Yasuo

doi:10.1016/j.jocn.2007.10.006

Cited by 3 publications

(1 citation statement)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It has been hypothesized that lymphocytes may become entrapped in the brain following an inflammatory response and may later undergo malignant transformation [ 2 , 12 ]. However, patients with inflammatory diseases of the CNS have not been shown to have an increased incidence of PCNSL [ 13 ], although there is a well-described increased incidence of lymphoma in patients with systemic inflammatory diseases [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Demyelination as a harbinger of lymphoma: a case report and review of primary central nervous system lymphoma preceded by multifocal sentinel demyelination

et al. 2016

View full text Add to dashboard Cite

BackgroundPrimary central nervous system lymphoma (PCNSL) may rarely be preceded by “sentinel demyelination,” a pathologic entity characterized by histologically confirmed demyelinating inflammatory brain lesions that mimic multiple sclerosis (MS) or acute disseminated encephalomyelitis (ADEM). Interpreting the overlapping radiologic and clinical characteristics associated with each of these conditions—contrast-enhancing demyelination of white matter and relapsing and remitting steroid-responsive symptoms respectively—can be a significant diagnostic challenge.Case presentationWe describe a 57-year-old woman with an unusual clinical course who presented with multi-focal enhancing white matter lesions demonstrated to be inflammatory demyelination by brain biopsy. Despite a good initial response to steroids and rituximab for treatment of presumed tumefactive multiple sclerosis, the patient’s condition rapidly deteriorated, and a repeat brain biopsy six months later was consistent with a diagnosis of diffuse large B-cell lymphoma.ConclusionsEarly clinical suspicion for PCNSL and awareness that biopsied lesions may initially show sentinel demyelination suggestive of alternate diagnoses may be essential for early initiation of appropriate therapies and mitigation of disease progression. Clinical, pathophysiological, and diagnostic aspects of sentinel demyelination and PCNSL are discussed.

show abstract