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Infectious meningitis mimicking recurrent medulloblastoma on magnetic resonance imaging. Case report
M Fouladi1, R Heideman, J W Langston
1Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA.
Abstract:
This report and the accompanying review of the literature address the challenges, when using surveillance magnetic resonance (MR) imaging, of establishing the origin of newly detected central nervous system lesions. Routine surveillance MR imaging in a 16-year-old boy, whose medulloblastoma had been successfully treated, demonstrated asymptomatic nodular leptomeningeal enhancement of the brain and spinal cord, which was consistent with recurrent disease. Examination of the cerebrospinal fluid, however, led to the diagnosis of bacterial meningitis. Two weeks after completion of antibiotic therapy, the original MR imaging findings were seen to have resolved. This case illustrates the importance of considering clinical and laboratory data, including results from a complete examination of the cerebrospinal fluid, when interpreting the origin of new lesions revealed by MR imaging.
Insights
Central nervous system lesions on surveillance MRI can mimic recurrent cancer. Bacterial meningitis was diagnosed via cerebrospinal fluid analysis, resolving MRI findings after antibiotic treatment.
Area of Science:
- Neurology
- Radiology
- Infectious Diseases
Background:
- Surveillance magnetic resonance (MR) imaging is crucial for monitoring treated central nervous system (CNS) cancers.
- Interpreting newly detected CNS lesions on surveillance MR imaging presents diagnostic challenges.
- Distinguishing between recurrent disease and other pathologies is vital for patient management.
Observation:
- A 16-year-old boy with a history of medulloblastoma presented with asymptomatic nodular leptomeningeal enhancement on surveillance MR imaging.
- The enhancement pattern was initially suggestive of recurrent medulloblastoma.
- Cerebrospinal fluid (CSF) examination revealed bacterial meningitis.
Findings:
- Prompt antibiotic therapy led to the complete resolution of the previously observed MR imaging findings.
- The case highlights that leptomeningeal enhancement can be caused by infectious processes, not solely by tumor recurrence.
- Integrated interpretation of imaging and laboratory data is essential.
Implications:
- Clinicians must consider infectious etiologies, such as bacterial meningitis, when interpreting new CNS lesions on surveillance MR imaging.
- Comprehensive cerebrospinal fluid analysis is critical for accurate diagnosis in such cases.
- This underscores the importance of a multidisciplinary approach in oncology follow-up.