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Washington University Experience | MYELIN (NON-IMMUNE MEDIATED) | Necrotizing Leukoencephalopathy | 8A0 Case 8 History
Case 8 History ---- The patient was a 51-year-old man with history of primary CNS lymphoma, deep vein thrombosis, pulmonary embolism and chronic hydrocephalus. In August 1998, he first presented with the subacute onset of language problems (difficulty in reading and in word finding). Head MRI revealed an enhancing lesion in the left posterior parietal lobe. He was diagnosed with malignant lymphoma, B cell type by brain biopsy. Patient was treated with intrathecal and intravenous methotrexate, high dose ARA-C and radiation. He responded to treatment well and was able to retain his job for more than one year. However, in late 2001, his symptoms recurred. MRI revealed a recurrent area of enhancement. The patient was treated with several courses of steroids, methotrexate and Temodar. Despite this, he continued deteriorating mentally. In April 2002, MRI revealed a new enhancing lesion in right hypothalamus and in August, 2002, the patient displayed new lesions involving right internal capsule and right medial globus pallidus. By that time he was globally aphasic and could not ambulate with decreased mental status. During the last admission on 8/12/02, the patient received an aggressive course of chemotherapy (methotrexate, vincristine, procarbazine) which was complicated by transient acute renal failure and persistent pancytopenia with neutropenia and fever. He was treated with vancomycin, cefepime, and acyclovir. The patient’s condition continued to worsen. Code status was changed to DNR/ DNI. The patient expired in September 2002.
