Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids following influenza vaccination.
Inflammatory processes within the central nervous system are challenging for the clinician, radiologist, and pathologist alike. They often can mimic other more well-known and defined disease processes. We present the case of a patient with a newly described inflammatory process that primarily involves the pons and adjacent structures, which is called chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS). An 80-year-old man presented with numbness of his right hand that ultimately progressed to involve both lower extremities and face and was associated with mild dysarthria and ataxia. He had received the influenza vaccination 2 weeks prior. The biopsy revealed primarily reactive T-cell lymphocytic infiltrates with macrophages and gliosis. Treatment required long-term immunosuppressive therapy. CLIPPERS is a recently described central nervous system inflammatory condition that should be considered in the differential diagnosis when a prominent lymphocytic inflammatory infiltrate is encountered in brainstem, spinal cord, midbrain, or cerebellar biopsies.
Department of Pathology and Laboratory Medicine, University of Louisville School of Medicine, 530S Jackson St, Louisville, KY 40202, USA. pbhill01@louisville.edu
Paul B
PB
Hillesheim
John R
JR
Parker
Joseph C
JC
Parker
Edward
E
Escott
Joseph R
JR
Berger
D000369:Aged, 80 and over; D002493:Central Nervous System Diseases / Q000188:drug therapy / Q000473:pathology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007249:Inflammation / Q000188:drug therapy / Q000473:pathology; D007252:Influenza Vaccines / Q000009:adverse effects*; D008214:Lymphocytes; D008297:Male; D011149:Pons / Q000187:drug effects / Q000473:pathology*; D013256:Steroids / Q000627:therapeutic use*
D007166:Immunosuppressive Agents; D007252:Influenza Vaccines; D013256:Steroids