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Washington University Experience | MYELIN (IMMUNE-MEDIATED) | AHL | AHL | 9A0 Case 9 History
Case 9 History (Thanks to my friend Arie Perry for sharing this case) ---- The patient is an 11 year old female with no significant past medical history. She had a Rhinovirus+ upper respiratory infection approximately 2 weeks prior to presentation to an OSH with altered mental status. MRI on 7/3 showed an expansile white matter mass lesion with hyperintensity on FLAIR exam interpreted as a possible neoplasm. A right frontal craniotomy with resection of the mass on 7/5 demonstrated a tumefactive demyelinating lesion consistent with AHL. On 7/6 repeat MRI showed progression with new involvement of the opposite hemisphere. On 7/13 there was an additional mild increase in the extent of T2/FLAIR hyperintensity in the left frontal lobe. The patient worsened progressively following the surgery with aphasia and weakness. CSF showed mild pleocytosis with 96 lymphocytes, normal protein and absence of oligoclonal bands. The patient was treated with IVIg, a course of steroids and plasmapheresis.
