[Progressive multifocal leukoencephalopathy with idiopathic CD4 positive T-lymphocytepenia mimicking a low grade glioma on proton MR spectroscopy. A case report].
A 61-year-old man with no history of HIV infection developed a subacutely progressive dementia and left hemiparesis. Brain MRI showed a high intensity lesion in the right frontal lobe on T2 weighted image. There was no contrast enhancement after gadolinium-DTPA administration. 1H MRS revealed a marked decrease in the n-acetyl aspartate/creatine ratios and an increase in the choline/creatine ratio. A lactate peak also was present. A low-grade glioma was suspected and he was admitted to our hospital. On examination, there was a mild dementia and left hemiparesis. A peripheral blood count revealed lymphocytopenia (426/mm3) with a CD4/CD8 ratio of 0.28. No evidence of HIV infection, malignancies or collagen disease was found. A brain biopsy revealed no tumor cells but instead demyelinated brain tissue with large nucleated cells. JC virus antigen was detected in the cells of the demyelinated lesions. A diagnosis of PML associated with idiopathic CD4 positive lymphocytopenia was made. There are only a few reports concerning 1H-MRS findings in patients with PML and the present case illustrates the difficulty of making a differential diagnosis between PML and glioma.
Kokubun
Norito
N
Department of Neurology, Dokkyo University, School of Medicine.
Ishihara
Tetsuya
T
Nishibayashi
Momoka
M
Ikeda
Syun-ichiro
S
Nagashima
Kazuo
K
Hirata
Koichi
K
D001932:Brain Neoplasms / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005910:Glioma / Q000175:diagnosis*; D006801:Humans; D007968:Leukoencephalopathy, Progressive Multifocal / Q000150:complications / Q000175:diagnosis*; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D018344:T-Lymphocytopenia, Idiopathic CD4-Positive / Q000150:complications*