ABSTRACT
A 45-year-old patient suffering from chronic renal insufficiency developed dermatopolymyositis. Since the patient did not respond to treatment with high doses of prednisone and immunoglobulin, concomitant cyclosporine A was added. Four months later, worsening signs of bilateral pyramidal disorder and an altered state of consciousness appeared. Serial computed tomography (CT) and magnetic resonance imaging (MRI) revealed multiple alterations of the cerebral white matter. Cyclosporine was then discontinued. One month later, exitus occurred. Microscopic examination of the brain showed diffuse tumescence; histological examination revealed perivascular and diffuse lymphomonocyte infiltrations, areas of demyelination, astrocytes with bizarre nuclei, and oligodendrocytes with enlarged nuclei due to hyperchromatic inclusion. Morphological examination confirmed the presence of intranuclear icosahedral viral bodies. Progressive multifocal leukoencephalopathy was diagnosed. The literature contains only one report of an analogous case observed during a course of cyclosporine treatment for Wegener's granulomatosis.
Subject(s)
Cyclosporine/adverse effects , Immunosuppressive Agents/adverse effects , Leukoencephalopathy, Progressive Multifocal/etiology , Papillomaviridae/isolation & purification , Papillomavirus Infections/complications , Polyomaviridae , Brain/pathology , Brain/virology , Cell Nucleus/ultrastructure , Cell Nucleus/virology , Dermatomyositis/complications , Dermatomyositis/drug therapy , Fatal Outcome , Female , Humans , Immunoglobulins, Intravenous/therapeutic use , Inclusion Bodies, Viral , Middle Aged , Papillomavirus Infections/diagnosis , Papillomavirus Infections/virology , Prednisolone/therapeutic use , Pyelonephritis/complications , Pyelonephritis/therapy , Renal DialysisABSTRACT
We describe the case of a 26 years old woman in chronic therapy with phenobarbital, carbamazepine, valproic acid (VPA) and clonazepam who showed a hyperammonemic encephalopathy after an increase in dosage of VPA. Similar cases have been reported, but with acute-subacute onset and no correlation with the plasma levels of VPA. Our case suggests the possibility that this toxic effect occurs during chronic treatment too, when the dosage of VPA is increased.
Subject(s)
Brain Diseases/chemically induced , Unconsciousness/chemically induced , Valproic Acid/adverse effects , Adult , Brain Diseases/physiopathology , Carbamazepine/therapeutic use , Clonazepam/therapeutic use , Electroencephalography , Epilepsies, Myoclonic/drug therapy , Epilepsies, Myoclonic/physiopathology , Female , Humans , Unconsciousness/physiopathology , Valproic Acid/therapeutic useABSTRACT
Some cases of chronic subdural haematomas (in patients aged from 17 to 27 years) with unusual symptomatology and difficult diagnosis are presented. The usefulness of cerebral scintigraphy which can clarify any diagnostic doubt and lead to a right neuroradiological behaviour is underlined.
