Subject(s)
Diabetes Mellitus, Type 1/immunology , Polyradiculoneuropathy, Chronic Inflammatory Demyelinating/immunology , Polyradiculoneuropathy, Chronic Inflammatory Demyelinating/therapy , Diabetes Mellitus, Type 1/etiology , Glucocorticoids/therapeutic use , Humans , Immunization, Passive , Male , Methylprednisolone/therapeutic use , Middle Aged , Polyradiculoneuropathy, Chronic Inflammatory Demyelinating/complications , Prednisone/therapeutic useABSTRACT
An 83-year-old man with chronic renal failure was referred to our hospital because of subacute progressive right hemiparesis. A brain MRI showed high-intensity lesions in bilateral middle cerebellar peduncles and white matter of the left frontal lobe on T2-weighted images. The lesions increased gradually, so we suspected a brain tumor because 1H-MRS images showed elevated Cho and decreased NAA, and also pathologic findings of the brain biopsy suggested glioblastoma. However, JC virus (JCV) in cerebrospinal fluid was revealed highly positive by PCR. So we reconsidered pathologically and finally found bizarre astrocytes which were infected with JCV in immunohistochemical studies and we diagnosed progressive multifocal leukoencephalopathy at last. Then we medicated with mefloquine and mirtazapine, and the JCV in cerebrospinal fluid disappeared, without new MRI lesions. This is a rare case in respect of the background of the patient and the clinical course.
Subject(s)
JC Virus/isolation & purification , JC Virus/pathogenicity , Kidney Failure, Chronic/complications , Leukoencephalopathy, Progressive Multifocal/drug therapy , Leukoencephalopathy, Progressive Multifocal/virology , Mefloquine/administration & dosage , Mianserin/analogs & derivatives , Aged, 80 and over , Astrocytes/virology , Brain/cytology , Brain/diagnostic imaging , Cerebrospinal Fluid/virology , Drug Therapy, Combination , Humans , Immunocompromised Host , Kidney Failure, Chronic/therapy , Leukoencephalopathy, Progressive Multifocal/diagnosis , Leukoencephalopathy, Progressive Multifocal/etiology , Magnetic Resonance Imaging , Male , Mianserin/administration & dosage , Mirtazapine , Renal Dialysis , Treatment OutcomeABSTRACT
Most patients with severe motor and intellectual disabilities (SMID) have restricted mobility capability and have been bedridden for long periods because of paralysis of the extremities caused by abnormal muscular tonicity due to cerebral palsy and developmental disabilities, and such patients are associated with a high risk for the complications of deep vein thrombosis (DVT). Here, we report 8 patients (34.8%) with DVT among 23 patients with SMID during prolonged bed rest. However, we did not detect thrombosis in the soleal veins, finding it mostly in the superficial femoral and common femoral veins. Regarding laboratory data for the coagulation system, there were no cases with D-dimer above 5 µg/ml. Concerning sudden death in patients with SMID, we have to be very careful of the possibility of pulmonary thromboembolism due to DVT. Therefore, we should consider the particularities of an underdeveloped vascular system from underlying diseases for the evaluation of DVT in patients with SMID. A detailed study of DVT as a vascular complication is very important for smooth medical care of SMID and compression Doppler ultrasonography of the lower extremities, as noninvasive examination, is very helpful. (English translation of Jpn J Phlebol 2012; 23: 17-24).
