Leukoencephalopathy resolution after atypical mycobacterial treatment: a case report.
BACKGROUND
Association of leukoencephalopathy and atypical mycobacteriosis has been rarely reported. We present a case that is relevant for its unusual presentation and because it may shed further light on the pathogenic mechanisms underlying reversible encephalopathies.


METHODS
We report the case of a Hispanic 64-year-old woman with cognitive decline and extensive leukoencephalopathy. Magnetic resonance imaging revealed white-matter lesions with increased water diffusivity, without blood-brain-barrier disruption. Brain biopsy showed tissue rarefaction with vacuolation, mild inflammation, few reactive astrocytes and decreased aquaporin water-channel expression in the lesions. Six months later, she was diagnosed with atypical mycobacterial pulmonary infection. Brain lesions resolved after antimycobacterial treatment.


CONCLUSIONS
We hypothesize leukoencephalopathic changes and vasogenic edema were associated with decreased aquaporin expression. Further studies should clarify if reversible leukoencephalopathy has a causal relationship with decreased aquaporin expression and atypical mycobacterial infection, and mechanisms underlying leukoencephalopathy resolution after antimycobacterial treatment. This article may contribute to the understanding of pathogenic mechanisms underlying magnetic resonance imaging subcortical lesions and edema, which remain incompletely understood.
Department of Neurology, Faculdade de Medicina da Universidade de Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, 5o andar, sala 5011, 05403-900, São Paulo, SP, Brazil. marcoscbo@hotmail.com.
Marcos C B
MC
Oliveira
Departments of Neurology, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan. douglas.sato@med.tohoku.ac.jp.
Douglas Kazutoshi
DK
Sato
Department of Neurology, Faculdade de Medicina da Universidade de Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, 5o andar, sala 5011, 05403-900, São Paulo, SP, Brazil. hervalneto@gmail.com.
Herval R
HR
Soares-Neto
Institute of Radiology, Faculdade de Medicina da Universidade de Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, 5o andar, sala 5011, 05403-900, São Paulo, SP, Brazil. ltlucato@gmail.com.
Leandro T
LT
Lucato
Department of Neurology, Faculdade de Medicina da Universidade de Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, 5o andar, sala 5011, 05403-900, São Paulo, SP, Brazil. dgcallegaro@yahoo.com.
Dagoberto
D
Callegaro
Department of Neurology, Faculdade de Medicina da Universidade de Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, 5o andar, sala 5011, 05403-900, São Paulo, SP, Brazil. rnitrini@uol.com.br.
Ricardo
R
Nitrini
Department of Pathology, Faculdade de Medicina da Universidade de Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, 5o andar, sala 5011, 05403-900, São Paulo, SP, Brazil. raphael.salles@gmail.com.
Raphael S S
RS
Medeiros
Multiple Sclerosis Therapeutics, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan. misu@med.tohoku.ac.jp.
Tatsuro
T
Misu
Multiple Sclerosis Therapeutics, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan. fujikazu@med.tohoku.ac.jp.
Kazuo
K
Fujihara
Department of Neurology, Faculdade de Medicina da Universidade de Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, 5o andar, sala 5011, 05403-900, São Paulo, SP, Brazil. castrolh@usp.br.
Luiz H
LH
Castro
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003072:Cognition Disorders / Q000188:drug therapy / Q000209:etiology; D005260:Female; D006801:Humans; D056784:Leukoencephalopathies / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D008171:Lung Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009165:Mycobacterium Infections, Nontuberculous / Q000175:diagnosis / Q000188:drug therapy*; D009170:Nontuberculous Mycobacteria; D066127:White Matter / Q000473:pathology
D000900:Anti-Bacterial Agents