Acute Hemorrhagic Leukoencephalitis as a Primary Presentation in an Immunocompromised Patient With Cerebral Toxoplasmosis
Neurology
; 98(18 SUPPL), 2022.
Article
in English
| EMBASE | ID: covidwho-1925340
ABSTRACT
Objective:
To draw attention towards a devastating presentation of Acute Hemorrhagic Leukoencephalitis (AHLE) in an immunocompromised patient with cerebral toxoplasmosis.Background:
AHLE is a rare, hyper-acute variant of Acute Disseminated Encephalomyelitis (ADEM). It is often preceded by an upper respiratory infection, and associated pathogens include influenza, Epstein Barr Virus (EBV), mycoplasma pneumonia, and SARS-CoV-2. Design/Methods:
NAResults:
A 27-year-old man presented to our hospital with a three day history of headaches and altered mental status. He was having seizures on arrival. He had a Glasgow Coma Scale (GCS) of 4 upon arrival. His pupils were anisocoric and sluggish to light. His brainstem reflexes were intact. Motor exam revealed extensor posturing in bilateral upper extremities and triple flexion in bilateral lower extremities in response to noxious stimuli. He received lorazepam in the emergency room with minimal improvement and was ultimately intubated for airway protection. Computed tomography (CT) head showed regions of hypoattenuation involving bilateral basal ganglia and thalami with superimposed acute hemorrhage, significant mass effect, and patchy regions of acute hemorrhage in the cerebellum. Magnetic resonance imaging (MRI) brain revealed areas of confluent FLAIR signal abnormality in the deep white matter, bilateral basal ganglia and thalami, brainstem, and throughout the cerebellum. He had a hypercellular cerebral spinal fluid (CSF) analysis that showed white blood cell count of 218 with lymphocytic predominance. Protein was elevated to 412 mg/dl and glucose was 17 mg/dl. He was found to be HIV-1 positive with a CD4 count of 6 cells per cubic centimeter. CSF specific toxoplasmosis PCR showed 730,000 copies/milliliter. He was treated with solumedrol and broad-spectrum antimicrobials with minimal improvement in his clinical picture and ultimately succumbed to his disease.Conclusions:
This report highlights AHLE as a rapidly progressive hemorrhagic demyelination of white matter. It is imperative to recognize it to implement life saving therapies earlier in the course.
glucose; lorazepam; methylprednisolone sodium succinate; acute hemorrhagic leukoencephalitis; adult; airway; basal ganglion; bleeding; brain stem; case report; CD4 lymphocyte count; cerebellum; cerebral toxoplasmosis; clinical article; computer assisted tomography; conference abstract; demyelination; drug therapy; emergency ward; fluid-attenuated inversion recovery imaging; Glasgow coma scale; headache; human; human cell; Human immunodeficiency virus 1; immunocompromised patient; leukocyte count; lower limb; lymphocyte; male; mental health; neuroimaging; nonhuman; nuclear magnetic resonance imaging; pupil; reflex; seizure; thalamus; toxoplasmosis; upper limb; white matter
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Collection:
Databases of international organizations
Database:
EMBASE
Language:
English
Journal:
Neurology
Year:
2022
Document Type:
Article
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