Leukoencephalopathy resolution after atypical mycobacterial treatment: a case report.

Abstract

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.

CASE REPORT:

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.

CONCLUSION:

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.

• Authors: Marcos C B Oliveira, Douglas Kazutoshi Sato, Herval R Soares-Neto, Leandro T Lucato, Dagoberto Callegaro, Ricardo Nitrini, Raphael S S Medeiros, Tatsuro Misu, Kazuo Fujihara, Luiz H Castro
• Journal: BMC neurology (BMC Neurol) Vol. 15 Pg. 159 (Sep 02 2015) ISSN: 1471-2377 [Electronic] England
• PMID: 26329680 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Bacterial Agents

Topics

• Anti-Bacterial Agents (therapeutic use)
• Cognition Disorders (drug therapy, etiology)
• Female
• Humans
• Leukoencephalopathies (drug therapy, etiology, pathology)
• Lung Diseases (diagnosis, drug therapy, microbiology)
• Magnetic Resonance Imaging
• Middle Aged
• Mycobacterium Infections, Nontuberculous (diagnosis, drug therapy)
• Nontuberculous Mycobacteria
• White Matter (pathology)