[A Case of Suspected Nonparaneoplastic Autoimmune Panencephalitis with Widespread Multifocal Brain Lesions and Treatable Dementia Following Pernicious Anemia: A Seven Year Follow-Up Study].

We present a case of a 73-year-old female who developed subacute memory disturbance, reduced consciousness and quadriparesis following pernicious anemia. Brain magnetic resonance imagings (MRI) in diffusion weighted, T2 weighted and fluid attenuated inversion recovery (FLAIR) images revealed hyperintensities in bilateral frontal, parietal, temporal and occipital cortices, left thalamus, bilateral splenium of corpus callosum, and bilateral subcortical white matters. Brain gadolinium enhanced T1 weighted MRI revealed very slight post-contrast enhancement lesions in the right posterior temporal region and bilateral parietal regions. Serum was negative for anti- aquaporin (AQP) 4 antibody, anti-glutamic acid decarboxylase (GAD) antibody and anti-voltage-gated potassium channel (VGKC) antibody, and cerebrospinal fluid (CSF) was negative for anti- N-methyl-D-aspartate (NMDA) receptor antibody. CSF analysis showed slight protein elevation with normal cellular content. No evidence of neoplasm was observed using whole-body 18 F -fluorodeoxyglucose- positron emission tomography/computed tomography. Pathological findings of the left frontal lesion revealed perivascular and scattered parechymal T-lymphocytic infiltration, and astrogliosis without vascular hyalinization. Patient achieved partial recovery during two intraveneous pulse methylprednisolone treatments, and exacerbation afterwards. After the third intraveneous pulse methylprednisolone treatment, remission is sustained for six years. This case can be regarded as autoantibody-negative but probable autoimmune encephalitis with the features of nonparaneoplastic panencephalitis and treatable dementia. Nonparaneoplastic autoimmune panencephalitis with widespread multifocal brain lesions on brain MRI is extremely rare, with exception of anti- NMDA receptor antibody encephalitis.

Predictors of the necessity for lymph node biopsy of cervical lymphadenopathy.

PURPOSE: Enlargement of cervical lymph nodes is required for early and accurate diagnosis of malignant lymphoma (ML). Lymph node biopsy is still indispensable for accurate diagnosis of lymph node enlargement in the lateral neck. MATERIAL AND METHODS: We retrospectively investigated the characteristics of lymph nodes on both ultrasonography (US) and computed tomography (CT), and blood biomarkers including serum thymidine kinase (TK) and soluble interleukin-2 receptor (sIL-2R) in 19 patients who underwent cervical lymph node biopsy. RESULTS: Pathological diagnosis was ML in 8 patients, reactive lymphadenopathy (RL) in 8, and purulent lymphadenitis (PL) in 3. TK levels were significantly higher in patients with ML than in patients with RL, demonstrating positive correlations with sIL-2R and lymph node size on CT image. The shape of lymph nodes on US in all of the 8 patients diagnosed with RL was flat, whereas the shape in 7 of 8 patients diagnosed with ML was round. Lymph node size ≥19.5 mm at an axial section on CT image was used as a cut-off value to differentiate ML from other pathologies, offering 90.9% sensitivity and 87.5% specificity. CONCLUSION: Sonographic and CT evaluation combined with high TK level might be useful in determining the need for early biopsy.

[Effect of glucocorticoids on bone mineral density in patients with idiopathic thrombocytopenic purpura].

To elucidate the effects of glucocorticoid on bone mineral density in idiopathic thrombocytopenic purpura (ITP) patients, we retrospectively evaluated the relationship between bone mineral density (BMD) and the total dose of glucocorticoid or the mean daily dose given. We found decreased BMD in 66.7% of the patients with ITP to whom glucocorticoid was given, though rather normal bone BMD was observed in 28.6% of ITP patients treated without steroids. The mean level of BMD was markedly decreased in steroid-treated patients compared with steroid non-treated patients (p < 0.01). The relationship between BMD and the total dose of glucocorticoid (p = 0.023) or the mean daily dose revealed a negative correlation (p = 0.022). This study showed that glucocorticoid-induced osteoporosis was observed in patients with ITP, similar to other diseases already reported. When we think of this disease, many cases tend to be followed for a long time, and as the majority of ITP patients is female, we should pay particular attention in the prevention of glucocorticoid-induced osteoporosis.