Multiple cerebral lesions in a patient with refractory celiac disease: A case report

• DOI: 10.3748/wjg.v26.i47.7584
• Publication Date: 2020-12-19T10:40:54Z
• Authors: Lena Horvath; Georg Oberhuber; Andreas Chott; Maria Effenberger; Herbert Tilg; Eberhard Gunsilius; Dominik Wolf; Sarah Iglseder
• Keywords: Refractory (planetary science)

Background Enteropathy-associated T cell lymphoma (EATL) is an aggressive intestinal derived from intraepithelial lymphocytes, which occurs in individuals with celiac disease (CD). Cerebral involvement extremely rare condition and as described so far, lesions may present parenchymal predo-minantly supratentorial or leptomeningeal involvement. We describe a case of EATL multifocal supra- infratentorial brain patient refractory (RCD). Case summary A 58-years old man known CD developed ulcerative jejunitis was diagnosed RCD type II. Six months later he presented subacute cerebellar symptoms (gait ataxia, double vision, dizziness). Cranial magnetic resonance imaging (MRI) revealed T2 hyperintense lesions. Laboratory studies blood cerebrospinal fluid were inconspicuous for infectious, inflammatory autoimmune diseases. 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18FDG-PET/CT) scan showed suspect hypermetabolic lesion the left upper abdomen consequent surgical jejunal resection diagnosis EATL. During diagnostic work-up, neurological aggravated evolved to high-dosage cortisone. Recurrent MRI scans progressive cerebral lesions, highly suspicious methotrexate chemotherapy initiated. Unfortunately, clinically responded only transiently. Finally, biopsy confirmed Considering poor prognosis deterioration performance status, best supportive care started. The passed away three weeks after diagnosis. Conclusion must be considered possible differential patients presenting symptoms.