spontaneous remission of a massive CNS inflammation with eosinophilic inflitrate

Case Details

Disease Location

Cns/left basal ganglia

Personal Characteristics

69 -year-old male, had an eosinophilic-infiltrate without any underlying condition known to cause idiopathic hyperesinophilic syndrome (ihes) no history of hypertension, allergies, or asthma; not on any medications; normal physical exams and neuro testing

Clinical Characteristics

Eosinophil without any systematic disorder or evidence of common causes of hypereosinophilia MRI suggested an infiltrating neoplasm, but biopsy and histological examination failed to show evidence of a neoplasm--the tissue showed rarefaction and gliosis with perivascular and parenchymal infiltrates of eosinophils. MRI showed a increased t2 signal in the left basal ganglia, there was heterogeneously iso- and low-intensity on t1 with slight enhancement after gadolinium-dpatienta. CT didn't show anything carotid and vertebral angiographiess were normal peripheral white cell count was 6,100 with 19.2% eosinophils multiple lab studies were normal (details in article csf showed glucose 85 mg/dl, protein 40 mg/dl, and wbc 1/µl with 1005 monocytes. No organisms and gamma globulin was normal eeg was normal, nerve conductions were normal, chest x-ray and cardiac and abdominal ultrasonograms were normal histological exam of specimen from biopsy demonstrated rarefaction and spongiosis of the neuropil, hypertrophic astrocytes and perivascular and parenchymal inflitrates of eosinophilic leukocytes. There was no necrosis perivascular cuffs contained mainly eosinophils and few lymphocytes. Immunostaining labeled most eosinophils were in the vessel wall and perivascular space, only few were in the vessel lumen immunohistochemical analysis showed eosinophils were immunostained with a monoclonal antibody to eosinophil cationic protein using the avidin-biotin-peroxidase complex method clinical and neuroimaging techniques were correlated with histopathology pattern of enhancements suggest infiltrating glioma rather than primary cns lymphoma (pcl)

Remission Characteristics

The abnormality found using MRI disappearing and blood eosinophilia normalized without treatment within 3 months 3 year neurological follow-up examination confirmed no recurrence

Treatment & Mechanisms

Clinical Treatment

Needle biopsy performed on left basal ganglia due to MRI findings of infiltrating neoplasm, specimens obtained from two different parts using stereotactic procedure

Non-Clinical Treatment

None reported