RATIONALE: We report the rare case of a 74-year-old man with anti-Ma2-associated paraneoplastic neurologic syndrome (PNS), and review and analyze the clinical manifestations, diagnosis, and treatment of the disease.
PATIENT CONCERNS: The patient presented with a 5-month history of muscle weakness, progressive body aches, and weakness and numbness in both lower extremities. Before his hospitalization, he had experienced cognitive function decline; ptosis, inward gaze, and vertical gaze palsy in the right eye; and occasional visual hallucinations. Brain and spinal cord magnetic resonance imaging (MRI) yielded normal results. Anti-Ma2 antibodies were detected in both serum and cerebrospinal fluid. A 4-hour electroencephalogram showed irregular sharp slow waves and δ waves in the temporal region. Electromyography showed peripheral nerve demyelination. Positron-emission tomography/computed tomography (PET-CT) examination revealed hypermetabolism in the lymph nodes of the whole body. Biopsy of the lymph nodes showed non-Hodgkin lymphoma.
DIAGNOSIS: A clinical diagnosis of lymphoma and PNS was made.
INTERVENTIONS: The patient was treated with intravenous dexamethasone (15 mg/day) for 3 days.
LESSONS: We have presented a rare case of a PNS involving both the central and peripheral nervous systems. The clinical features of this case indicated anti-Ma2-associated encephalitis and chronic inflammatory demyelinating polyneuropathy. PET-CT played a critical role in enabling early diagnosis and prompt treatment in this case.
... VZV-specific T-cells from CSF and blood were significantly increased in VZV-related CNS-infections (p = 0.0002 and p <0.0001) and clearly identified VZV-related CNS-diseases (100% sensitivity ... T-cells from CSF or blood are specifically found in patients with VZV-related CNS-infection... All rights reserved Keyword: CNS-infection.
Infections (5), Central Nervous System Infections (1), Leukocytosis (1), more mentions
Abstract: Cryptococcus gattii species complex has evolved as a pathogen in the last two decades causing infection among both immunocompetent and immunocompromised hosts. We aimed to analyse the clinical features of CNSinfection caused by C. gattii sensu lato, molecular and antifungal susceptibility profile of this pathogen... Keyword: CNSinfection. Keyword: antifungal susceptibility.
Infectious Diseases (1) Infections (3), Cryptococcosis (1), Central Nervous System Infections (1), more mentions
... to be P. acnes, 61 of which were from the CNS (45 contaminants, 16 infections... 1 was more common (50.0%, 8 out of 16) among CNSinfections than among contaminants (22.2%, 10 out of 45... type IA-1 was isolated more often in patients with CNSinfections, which may indicate a predilection of this strain type to cause CNSinfection ...
... recognition and appropriate treatment are crucial because of its potentially fatal complications and lack of response to beta-lactam antibiotics. The present study retrospectively evaluated the clinical characteristics and laboratory findings of 16 patients with scrub typhus-related centralnervoussystem (CNS) infections... An empirical treatment with doxycycline is needed in patients with CNSinfections in scrub typhus endemic areas.
Infectious Diseases (1) Infections (3), Scrub Typhus (2), Central Nervous System Infections (1), more mentions
BACKGROUND: Historically considered to have very poor outcome, there is paucity of recent data regarding invasive mold infections (IMIs) of the central nervous system (CNS) in patients with hematologic cancer (HC) or stem cell transplantation (SCT).
METHODS: We reviewed the records of HC patients and/or SCT recipients who were diagnosed with CNS IMIs (EORTC/MSG criteria) at MD Anderson Cancer Center (1/1/2000-6/31/2016). Risk factors for survival at day (d) 42 post diagnosis were assessed.
RESULTS: We identified 40 such patients (16 with proven infection). The incidence density was 3.8 cases/100000 patient days and mortality remained stable throughout the study period. Most patients had active HC and neutropenia at diagnosis (95% and 53% respectively). Of the 25 patients with a microbiological diagnosis, Aspergillus spp and Mucorales accounted for 85% of cases. CNS IMIs were deemed to be secondary to hematogenous spread in 31 (77%), mostly (90%) fungal pneumonia. CNS lesions typically presented as a solitary ring-enhancing abscesses in MRI (26; 65%). Most patients (34; 85%) received lipid AMB and were treated with combination therapy (33; 83%); Mortality 42d was 48 %. In univariate analysis, lack of surgical drainage (p=0.01), absence of giant cells (p=0.01) and granulomas (p=0.03) were associated with increased 42d mortality. In multivariate analysis, co-infection was associated with increased (p=0.005), while steroid tapering (p=0.01) was associated with decreased mortality.
CONCLUSIONS: Although less lethal, improved outcome in these uncommon infections was related only to immune response in histopathology, steroid tapering and possibly surgical drainage.
Oncology (3) Infections (4), Neoplasms (3), Granuloma (1), more mentions
Lumbar puncture should be performed in all patients with suspected CNSinfection unless there are contraindications... Seizures should be treated as any other symptomatic epileptic seizures AbstractText: Tick-borne encephalitis is a viral CNSinfection that may result in long-term neurological sequelae. Since its incidence in Europe is increasing due to broadening of endemic areas and prolongation of the ...
Infectious Diseases (2), Immune System Diseases (2), Neurological and Central Nervous System Diseases (1) Tick-Borne Encephalitis (5), Infections (5), Meningoencephalitis (2), more mentions
RATIONALE: Spinal epidural abscess is an uncommon complication in clinical practice. If the abscess is large enough, the patient will rapidly develop neurologic signs of spinal injury, and urgent neurosurgical intervention may be required.
PATIENT CONCERNS: Rapid and correct diagnosis and treatment is important for spinal epidural abscess complication.
DIAGNOSES: This report describes a cervical epidural abscess (CEA) caused by epidural analgesia, wherein the patient was punctured twice. A CEA was suspected based on the patient's significant neck pain and elevated white blood cell and neutrophil counts. A CEA from C6 to T8 was confirmed by magnetic resonance imaging scan.
INTERVENTIONS: The patient was treated with a combination of intravenous vancomycin and imipenem/cilastatin for more than 4 weeks.
OUTCOMES: After more than 2 weeks of intensive antibiotic treatment, the epidural abscess gradually diminished in size, the white blood cell count, neutrophil count, hyperallergic C-reactive protein (CRP), and general CRP decreased, and the patient's neck and back pain resolved. After more than 4 weeks of anti-inflammation therapy, the epidural abscess was completely absorbed, and there was no relapse during the 3-month follow-up period.
LESSONS: Although an effective combination of intravenous antibiotics can cure an epidural abscess, caution is warranted when performing epidural steroid injections in immunocompromised patients.
The factors that were significantly associated with death in the multivariate analysis were age, history of ischemic cardiac disease, and neurological diagnoses of CNSinfection, cerebrovascular disease, and CNS tumor. Similarly, factors associated with disability were medical history of HIV, and cerebrovascular disease, and neurological diagnoses of cerebrovascular disease and CNS tumor.
Neurological and Central Nervous System Diseases (1), Neuroscience (1) Neoplasms (2), Epilepsy (1), Heart Diseases (1), more mentions
Microorganisms can affect the entire neuraxis, producing a variety of neurologic complications that frequently entail prolonged hospitalizations and complicated treatment regimens. The spread of pathogens to new regions and the reemergence of opportunistic organisms in immunocompromised patients pose increasing challenges to healthcare professionals. Since rapid diagnosis and treatment may prevent long-term neurologic sequelae, providers should approach these diseases with a structured, neuroanatomic framework, incorporating a thorough history, exam, laboratory analysis, and neuroimaging in their clinical reasoning and decision-making.
A retrospective medical chart review was performed and the indications and results of surgical interventions were recorded.All surgeries were performed for the treatment of secondary complications of ORN, including central nervous system (CNS) infection (48.4%), blowout bleeding (24.1%), and severe pain (17.2. Endoscopic debridement was done in 12 patients, whereas the rest required either maxillary swing or mandibulotomy, depending ...
OBJECTIVE: To retrospectively analyze the effect of plasma exchange (PLEX, yes=PLEX+, no=PLEX-) and steroids administration timing (prophylactically -proST- or therapeutically -therST-) on the longitudinal clinical course of patients with natalizumab related progressive multifocal leukoencephalopathy (PML) and full blown immune reconstitution inflammatory syndrome (PML-IRIS).
METHODS: Clinical and radiological data of 42 Italian patients with PML were analyzed. Patient's data are available until 12 months after PML diagnosis. PLEX and steroids treatment as time-dependent covariates were entered in: i) a Cox model to investigate their impact on full blown PML-IRIS latency; ii) an ANOVA to investigate their impact on IRIS duration; iii) a linear mixed model to assess their impact on the longitudinal clinical course (measured by means of EDSS).
RESULTS: Treatment with PLEX was not associated to PML-IRIS latency (HR=1.05, p=0.92), but once IRIS emerged, its duration was significantly longer in patients who underwent PLEX (101 vs 54 days in PLEX+ and PLEX- patients, p=0.028). Receiving proST vs therST was not associated to IRIS latency (HR=0.67, p=0.39) or duration (p=0.95). Patients who underwent proST had a significant higher EDSS increase during PML (0.09 EDSS points per month, p=0.04) as compared to those who had therST.
INTERPRETATION: this study highlights that: i) caution on the use of PLEX should be considered as the current data do not support a beneficial effect of PLEX; ii) caution on the early use of steroids is suggested since their prophylactic use to prevent full blown PML-IRIS seems to negatively impact on the longitudinal disability course. This article is protected by copyright. All rights reserved.
Immune System Diseases (1) Progressive Multifocal Leukoencephalopathy (2), Immune Reconstitution Inflammatory Syndrome (2), Multiple Sclerosis (1), more mentions
We report rabies virus transmission among solid organ transplantation recipients in Changsha, China, in 2016. Two recipients were confirmed to have rabies and died. Our findings suggest that more attention should be paid to the possibility of rabies virus transmission through organ transplantation for clinical and public health reasons.
INTRODUCTION: Severe attacks of neuromyelitis optica spectrum disorder (NMO-SD) are improved by plasma exchange (PLEX) given as an adjunctive therapy. Initial studies failed to demonstrate a delay of PLEX treatment influenced clinical outcome; however PLEX was always used late. We examine the clinical consequences of delay in PLEX initiation on severe optic neuritis and spinal cord attacks in NMO-SD.
METHODS: All of our patients who suffered attacks of NMO-SD, treated in our centre by PLEX, were retrospectively considered for inclusion. Primary outcome was defined as complete improvement. Secondary poor/good outcomes were respectively defined to be the higher/lower third of Delta-Expanded Disability Status Scale (EDSS) (late minus baseline EDSS). Delays from clinical onset to PLEX initiation were categorised for multivariate analysis.
RESULTS: Of the 60 patients included, NMO-SD criteria (2015) were fulfilled in 92%. One hundred and fifteen attacks were included and received PLEX with a median of 7 days (0-54) after clinical onset. The probability to regain complete improvement continuously decreased from 50% for PLEX given at day 0 to 1%-5% after day 20. Through multivariate analysis, the baseline impairment and PLEX delay were associated with the probability to complete improvement (OR 5.3; 95% CI 1.8 to 15.9). Reducing the PLEX delay also influenced the good secondary outcome but not the poor secondary outcome.
CONCLUSIONS: These results confirm an improved clinical benefit of early initiation of PLEX during severe attacks of NMO-SD. Perceiving PLEX as a rescue therapy only after steroid failure could be deleterious.