QUIZ: No. 4, Mar 23 , 2025

Case 4 (23/03/2025): An 18-year-old female presented with complaints of weakness of her lower limb. She had an unexplained fever and was started on ATT which was stopped due to hepatotoxicity. She was also diagnosed with autoimmune hemolytic anaemia.  MRI Brain images were provided. What’s your diagnosis?

CASE 4

An 18-year-old female presented with complaints of weakness of her lower limb. She had an unexplained fever and was started on ATT which was stopped due to hepatotoxicity. She was also diagnosed with autoimmune hemolytic anaemia.  MRI Brain images were provided. What’s your diagnosis?

ANS – CNS vasculitis (Systemic lupus erythematosus).

Findings: Multiple infarctions affecting different vascular regions. MRA images depict multiple irregularities and stenosis of multiple distal artery branches.

CNS vasculitis is characterized by multiple infarctions, typically bilateral, affecting different vascular territories, are of variable size, and are in various stages of healing.

MR angiography may show multifocal intracranial arterial narrowing and/or beading of both small and medium-sized blood vessels.

CNS vasculitis is managed with high-dose corticosteroids and other immunosuppressive agents

Take home points

•        Bilateral asymmetric infarctions in different vascular territories and varying stages should prompt the diagnosis of CNS vasculitis.

P.S – This patient had dsDNA POSITIVE in ANA profile and she improved after treatment with steroids and hydroxychloroquine.