Non-HTLV-I associated pleomorphic T-cell lymphoma of the brain mimicking post-vaccinal acute inflammatory demyelination.
Two weeks after vaccination against tick-borne encephalitis (TBE), a 57-year-old female suddenly developed mental confusion and hemiparesis of the left side. Cranial MRI demonstrated extensive bilateral lesions in the fronto-parietal white matter of both hemispheres, suggesting an acute inflammatory demyelinating disease following vaccination. Despite administration of high-dose corticosteroids, the patient died 3 weeks after onset of neurological symptoms. Autopsy revealed diffuse infiltrates of a primary cerebral pleomorphic T-cell lymphoma of medium and large cell type. PCR on brain tissue for HTLV-I and serology for anti-HTLV-I antibodies in CSF and serum were negative; immunocytochemistry on brain tissue did not detect EBV-related antigen. This is the first recorded observation of a diffusely infiltrating primary central nervous system T-cell lymphoma, clinically and radiologically mimicking a fatal acute inflammatory demyelinating complication after vaccination.
Wanschitz
J
J
Institute of Neurology, University of Vienna, Austria.
Hainfellner
J A
JA
Simonitsch
I
I
Schnizer
M
M
Deisenhammer
E
E
Terunuma
H
H
Iwasaki
Y
Y
Budka
H
H
D001932:Brain Neoplasms / Q000473:pathology*; D003711:Demyelinating Diseases / Q000473:pathology*; D005260:Female; D006801:Humans; D016399:Lymphoma, T-Cell / Q000473:pathology*; D008875:Middle Aged; D013997:Time Factors; D014611:Vaccination / Q000009:adverse effects*