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Xie L, Liu T, Yao H, Wu L, Qiu W, Chen B, Liu S, Huang Q, Yang H, Xu H, Long Y, Gao C. Autoimmune inflammatory meningoencephalitis in a patient negative for glial fibrillary acidic protein-specific immunoglobulin G. Mult Scler Relat Disord 2018; 28:167-171. [PMID: 30605794 DOI: 10.1016/j.msard.2018.12.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 11/08/2018] [Accepted: 12/28/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND In this study, we describe clinical findings in a patient with autoimmune inflammatory meningoencephalitis who was negative for antibodies against glial fibrillary acidic protein (GFAP-IgG). METHODS Serum and cerebral spinal fluid (CSF) samples were collected from the patient as part of a study of 520 patients with neurological syndromes. Antibodies against GFAP and other proteins associated with neurological disorders were measured by rat brain- and cell-based indirect immunofluorescence assays. RESULTS A 42-year-old female was diagnosed with autoimmune inflammatory meningoencephalitis. She experienced a subacute and relapsing course with decreased vision, fever, headache, ataxia, hemiplegia, and disturbance of consciousness. Brain magnetic resonance imaging showed extensive lesions in the white matter along the ventricle, brainstem, right internal capsule, and meninges. The patient responded well to steroid treatment. Examination of CSF revealed a normal white blood cell count and protein level. Serum and CSF were negative for GFAP-specific antibodies and all other autoantibodies tested. Immunohistochemical staining of a brain biopsy collected during relapse revealed chronic inflammation and severe edema. Extensive and strong staining of CD163+ macrophages were evident throughout the lesions; however, CD3+ cells were rare and CD138+ and CD20+ cells were absent. CONCLUSION We describe a case of subacute corticosteroid-responsive nonvasculitic autoimmune inflammatory meningoencephalitis in the absence of GFAP-IgG. The pathological features were distinct from those of patients with GFAP-IgG-positive meningoencephalitis, suggesting that nonvasculitic autoimmune inflammatory meningoencephalitis is a heterogeneous neurological syndrome.
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Affiliation(s)
- Longchang Xie
- Department of Neurology, the Second Affiliated Hospital of GuangZhou Medical University, 250# Changgang east Road, Guangzhou 510260, Guangdong Province, China; Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Collaborative Innovation Center for Neurogenetics and Channelopathies, 250# Changgang east Road, Guangzhou 510260, Guangdong Province, China
| | - Tianni Liu
- Department of Neurology, the Second Affiliated Hospital of GuangZhou Medical University, 250# Changgang east Road, Guangzhou 510260, Guangdong Province, China; Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Collaborative Innovation Center for Neurogenetics and Channelopathies, 250# Changgang east Road, Guangzhou 510260, Guangdong Province, China
| | - Haiyan Yao
- Department of Neurology, the Second Affiliated Hospital of GuangZhou Medical University, 250# Changgang east Road, Guangzhou 510260, Guangdong Province, China; Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Collaborative Innovation Center for Neurogenetics and Channelopathies, 250# Changgang east Road, Guangzhou 510260, Guangdong Province, China
| | - Linzhan Wu
- Department of Neurology, the Second Affiliated Hospital of GuangZhou Medical University, 250# Changgang east Road, Guangzhou 510260, Guangdong Province, China; Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Collaborative Innovation Center for Neurogenetics and Channelopathies, 250# Changgang east Road, Guangzhou 510260, Guangdong Province, China
| | - Wei Qiu
- Department of Neurology, The Third Affiliated Hospital of Guangzhou Medical University, 63# Duobao Road, Guangzhou 510150, China
| | - Baikeng Chen
- Department of Neurology, the Second Affiliated Hospital of GuangZhou Medical University, 250# Changgang east Road, Guangzhou 510260, Guangdong Province, China; Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Collaborative Innovation Center for Neurogenetics and Channelopathies, 250# Changgang east Road, Guangzhou 510260, Guangdong Province, China
| | - Si Liu
- Department of Neurology, the Second Affiliated Hospital of GuangZhou Medical University, 250# Changgang east Road, Guangzhou 510260, Guangdong Province, China; Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Collaborative Innovation Center for Neurogenetics and Channelopathies, 250# Changgang east Road, Guangzhou 510260, Guangdong Province, China
| | - Qingmei Huang
- Department of Neurology, the Second Affiliated Hospital of GuangZhou Medical University, 250# Changgang east Road, Guangzhou 510260, Guangdong Province, China; Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Collaborative Innovation Center for Neurogenetics and Channelopathies, 250# Changgang east Road, Guangzhou 510260, Guangdong Province, China
| | - Huacai Yang
- Department of Neurology, the Second Affiliated Hospital of GuangZhou Medical University, 250# Changgang east Road, Guangzhou 510260, Guangdong Province, China; Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Collaborative Innovation Center for Neurogenetics and Channelopathies, 250# Changgang east Road, Guangzhou 510260, Guangdong Province, China
| | - Huiming Xu
- Department of Neurology, the Second Affiliated Hospital of GuangZhou Medical University, 250# Changgang east Road, Guangzhou 510260, Guangdong Province, China; Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Collaborative Innovation Center for Neurogenetics and Channelopathies, 250# Changgang east Road, Guangzhou 510260, Guangdong Province, China
| | - Youming Long
- Department of Neurology, the Second Affiliated Hospital of GuangZhou Medical University, 250# Changgang east Road, Guangzhou 510260, Guangdong Province, China; Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Collaborative Innovation Center for Neurogenetics and Channelopathies, 250# Changgang east Road, Guangzhou 510260, Guangdong Province, China.
| | - Cong Gao
- Department of Neurology, the Second Affiliated Hospital of GuangZhou Medical University, 250# Changgang east Road, Guangzhou 510260, Guangdong Province, China; Institute of Neuroscience and The Second Affiliated Hospital of Guangzhou Medical University, Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Collaborative Innovation Center for Neurogenetics and Channelopathies, 250# Changgang east Road, Guangzhou 510260, Guangdong Province, China
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Boisch G, Duda S, Hartmann C, Weßling H. Hypertrophic pachymeningoencephalitis associated with temporal giant cell arteritis. BMJ Case Rep 2018; 2018:bcr-2018-225304. [PMID: 30262524 DOI: 10.1136/bcr-2018-225304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report the rare case of an 80-year-old male patient with hypertrophic pachymeningoencephalitis that may be associated with temporal arteritis. The patient presented to our neurological department with a 2-week history of latent paresis and ataxia affecting his right hand. He had been diagnosed with temporal arteritis 12 years earlier. Brain MRI showed an enhancement of the left-sided frontoparietal meninges with oedema of the adjacent tissue of the precentral and postcentral cortex. A leptomeningeal biopsy was performed. An autoimmune-mediated immunoglobulin G4-associated hypertrophic pachymeningoencephalitis was diagnosed. The patient received a high-dose corticosteroid therapy and his symptoms gradually improved. Our results suggest that hypertrophic pachymeningoencephalitis may occur as a complication of giant cell arteritis and may cause central neurological deficits by cerebral perifocal oedema.
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Affiliation(s)
- Gesine Boisch
- Department of Neurology, Ammerland Klinik GmbH, Westerstede, Germany
| | - Sven Duda
- Department of Neurosurgery, Bundeswehrkrankenhaus Westerstede, Westerstede, Germany
| | - Christian Hartmann
- Department of Neuropathology, Medizinische Hochschule Hannover, Hannover, Germany
| | - Heinrich Weßling
- Department of Neurosurgery, Bundeswehrkrankenhaus Westerstede, Westerstede, Germany
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Kanoke A, Ogawa Y, Watanabe M, Kumabe T, Tominaga T. Autoimmune hypophysitis presenting with intracranial multi-organ involvement: three case reports and review of the literature. BMC Res Notes 2013; 6:560. [PMID: 24373428 PMCID: PMC3877864 DOI: 10.1186/1756-0500-6-560] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 12/16/2013] [Indexed: 11/23/2022] Open
Abstract
Background Autoimmune hypophysitis very rarely spreads to nearby organs outside the pituitary tissue, for unknown reasons, with only 5 reported cases of hypophysitis spreading over the cavernous sinus. Case presentation Three patients presented with cases of non-infectious hypophysitis spreading outside the pituitary tissue over the cavernous sinus. All three cases were diagnosed with histological confirmation by transsphenoidal surgery, and the patients showed remarkable improvement with postoperative pulse dose steroid therapy, including disappearance of abnormal signal intensities in the bilateral hypothalami on magnetic resonance imaging, resolution of severe stenosis of the internal carotid artery, and normalization of swollen pituitary tissues. Two of 3 cases fulfilled the histological criteria of immunoglobulin G4-related disease, although none of the patients had high serum immunoglobulin G4 level. Conclusion The true implications of such unusual spreading of hypophysitis to nearby organs are not fully understood, but the mechanism of occurrence might vary according to the timing of inflammation in this unusual mode of spreading. Pulse dose steroid therapy achieved remarkably good outcomes even in the patient with progressive severe stenosis of the internal carotid artery and rapid visual deterioration.
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Affiliation(s)
| | - Yoshikazu Ogawa
- Department of Neurosurgery, Kohnan Hospital, 4-20-1 Nagamachiminami, Taihaku-ku, Sendai 982-8523, Miyagi, Japan.
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Kim EH, Kim SH, Cho JM, Ahn JY, Chang JH. Immunoglobulin G4–related hypertrophic pachymeningitis involving cerebral parenchyma. J Neurosurg 2011; 115:1242-7. [DOI: 10.3171/2011.7.jns1166] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report a case of IgG4-related hypertrophic pachymeningitis that involved cerebral parenchyma. The mass was removed surgically. Histopathological studies showed diffuse infiltration of lymphoplasmacytic cells without evidence of Langerhans histiocytes or meningothelial cells. Immunoglobulin G4 was strongly positive on immunohistochemical staining. The Gd-enhanced lesion deep inside brain parenchyma was completely resolved after 3 months of oral corticosteroid medication. A nodular type of hypertrophic pachymeningitis that mimics a meningioma is rare. Nevertheless, preoperative presumption is very important, and immunohistochemical studies for IgG4 may be helpful in the differential diagnosis.
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Affiliation(s)
- Eui Hyun Kim
- 1Departments of Neurosurgery and
- 3Neuro-Oncology Clinic, and
| | - Se Hoon Kim
- 2Pathology,
- 3Neuro-Oncology Clinic, and
- 4Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Mo Cho
- 1Departments of Neurosurgery and
- 3Neuro-Oncology Clinic, and
| | | | - Jong Hee Chang
- 1Departments of Neurosurgery and
- 3Neuro-Oncology Clinic, and
- 4Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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