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A 47-year-old man had a fever of 39℃, weight loss and night sweat 4 months before admission. Two months later he presented with diplopia, and developed gait disturbance another month later. He was admitted because of disturbed consciousness with a Mini-Mental State Examination score of 24. Brain MRI with fluid-attenuated inversion recovery findings on admission showed bilateral asymmetric high intensity with partial mild swelling on white matter, corpus callosum, cerebellum and brainstem (figure 1A, B). Enhanced MRI detected punctate and curvilinear enhancement suggestive of perivascular infiltration and nodular enhancement (figure 1C, D). A cerebrospinal fluid analysis showed a cell count of 11 cells/µL (mononuclear cells: 94%), an elevated protein level (101 mg/dL). The oligoclonal bands were negative. IgG index was 0.5.
Contributors TK was the attending doctor of the patient and performed neurological examination, prescribed medicines and made a decision about the patient's management. SM served scientific advices about MRI findings. KK served scientific advices about anti-MOG antibody. TF served scientific advices about neuropathology.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Obtained.
Ethics approval The Regional Ethics and Hospital Management Committee of Jikei University School of Medicine approved the study (approval number 30-089).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All authors had access to the data and a role in writing the manuscript.