神经胶质过多装扮成一个肉芽肿的大脑过程(P4.225)

文摘

背景:神经胶质过多大脑是一种罕见的原发性脑瘤的特点是弥漫性肿瘤浸润通常呈现在三或四年的生活。我们提出的神经胶质过多模仿一个肉芽肿的过程。案例:38岁的女人6 - 8周的特异性的背部疼痛和头痛被送至医院后发现没有响应。腰椎穿刺显示> 1000红血球,45白细胞,蛋白质> 1000。MRI大脑显示多个领域的异常T2延长和弥漫性结节leptomeningeal增强。她有一个广泛的引起自身免疫(Anti-Ro /洛杉矶,安娜,anti-dsDNA anti-cardiolipin抗体,RNP, RF),肉芽肿(ANCA, ACE)、感染(脑炎面板、带状疱疹、艾滋病、包柔氏螺旋体、布鲁氏菌、HTLV,梅毒,Coccidiomycosis,痢疾,分枝杆菌,隐球菌,立克次氏体、弓形虫),脱髓鞘(寡克隆条带,anti-NMO MBP)、毒理学和多种(包括anti-NMDA)障碍。三个脑脊液细胞学和流式细胞术评估是不起眼的,就像CT胸部或腹部/骨盆。她的评价是显著的低水平的补充,阳性血清JC病毒,CSF白蛋白高,低CD4细胞计数(225)。她与大剂量强的松治疗经验,氨苄青霉素,头孢曲松钠,无环鸟苷,改善基线,出院回家后15天,并恢复正常的活动(如洗衣、做饭),虽然易疲劳性增加。不幸的是,不到一个星期后她重新提出与降低口腔摄入、呕吐、癫痫发作。 CT head revealed acute hydrocephalus. Repeat MRI brain revealed interval worsening of the nodular enhancement “consistent with granulomatous meningitis” and stable intraparenchymal T2 abnormality “suggestive of encephalitis”. MRI spine showed diffuse thoracolumbar nodular thickening and leptomeningeal enhancement. She underwent dural and optico-carotid lesion biopsies. The optico-carotid lesion revealed high-grade astrocytic tumor; she was diagnosed with gliomatosis cerebri. Her family elected to pursue a palliative course. She passed away less than 8 weeks after initial presentation. Conclusions: It is important to consider neoplastic etiologies in the differential of granulomatous processes, even when preliminary neoplastic evaluation is unremarkable.

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