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Disseminated Necrotizing Leukoencephalopathy Complicating Septic Shock in an Immunocompetent Patient
Disseminated necrotizing leukoencephalopathy (DNL) is characterized by multiple microscopic foci of white matter necrosis. DNL was initially thought to be exclusively associated with immunosuppression conditions but it has been recently described in immunocompetent patients in septic shock. A 90-yea...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Hindawi
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5420918/ https://www.ncbi.nlm.nih.gov/pubmed/28523195 http://dx.doi.org/10.1155/2017/1092537 |
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author | Gaspar-da-Costa, Pedro Reimão, Sofia Braz, Sandra Santos, João Meneses Victorino, Rui M. M. |
author_facet | Gaspar-da-Costa, Pedro Reimão, Sofia Braz, Sandra Santos, João Meneses Victorino, Rui M. M. |
author_sort | Gaspar-da-Costa, Pedro |
collection | PubMed |
description | Disseminated necrotizing leukoencephalopathy (DNL) is characterized by multiple microscopic foci of white matter necrosis. DNL was initially thought to be exclusively associated with immunosuppression conditions but it has been recently described in immunocompetent patients in septic shock. A 90-year-old immunocompetent woman with no previous neurological impairment presented with septic shock and drowsiness that responded well to therapy with clinical improvement and a full neurological recovery. Unexpectedly deterioration with progression to coma occurred. Investigation excluded other causes and Magnetic Resonance Imaging (MRI) was consistent with the diagnosis of DNL showing bilateral multifocal white matter lesions with a nonvascular pattern with restricted diffusion. Neurological impairment persisted with progression to death. DNL is an unexpected diagnosis in an immunocompetent patient. We compared the present case to those found in the literature of DNL complicating septic shock and discuss the antemortem diagnosis based on MRI findings. |
format | Online Article Text |
id | pubmed-5420918 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Hindawi |
record_format | MEDLINE/PubMed |
spelling | pubmed-54209182017-05-18 Disseminated Necrotizing Leukoencephalopathy Complicating Septic Shock in an Immunocompetent Patient Gaspar-da-Costa, Pedro Reimão, Sofia Braz, Sandra Santos, João Meneses Victorino, Rui M. M. Case Rep Crit Care Case Report Disseminated necrotizing leukoencephalopathy (DNL) is characterized by multiple microscopic foci of white matter necrosis. DNL was initially thought to be exclusively associated with immunosuppression conditions but it has been recently described in immunocompetent patients in septic shock. A 90-year-old immunocompetent woman with no previous neurological impairment presented with septic shock and drowsiness that responded well to therapy with clinical improvement and a full neurological recovery. Unexpectedly deterioration with progression to coma occurred. Investigation excluded other causes and Magnetic Resonance Imaging (MRI) was consistent with the diagnosis of DNL showing bilateral multifocal white matter lesions with a nonvascular pattern with restricted diffusion. Neurological impairment persisted with progression to death. DNL is an unexpected diagnosis in an immunocompetent patient. We compared the present case to those found in the literature of DNL complicating septic shock and discuss the antemortem diagnosis based on MRI findings. Hindawi 2017 2017-04-24 /pmc/articles/PMC5420918/ /pubmed/28523195 http://dx.doi.org/10.1155/2017/1092537 Text en Copyright © 2017 Pedro Gaspar-da-Costa et al. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Case Report Gaspar-da-Costa, Pedro Reimão, Sofia Braz, Sandra Santos, João Meneses Victorino, Rui M. M. Disseminated Necrotizing Leukoencephalopathy Complicating Septic Shock in an Immunocompetent Patient |
title | Disseminated Necrotizing Leukoencephalopathy Complicating Septic Shock in an Immunocompetent Patient |
title_full | Disseminated Necrotizing Leukoencephalopathy Complicating Septic Shock in an Immunocompetent Patient |
title_fullStr | Disseminated Necrotizing Leukoencephalopathy Complicating Septic Shock in an Immunocompetent Patient |
title_full_unstemmed | Disseminated Necrotizing Leukoencephalopathy Complicating Septic Shock in an Immunocompetent Patient |
title_short | Disseminated Necrotizing Leukoencephalopathy Complicating Septic Shock in an Immunocompetent Patient |
title_sort | disseminated necrotizing leukoencephalopathy complicating septic shock in an immunocompetent patient |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5420918/ https://www.ncbi.nlm.nih.gov/pubmed/28523195 http://dx.doi.org/10.1155/2017/1092537 |
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