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Human growth hormone-related iatrogenic Creutzfeldt-Jakob disease with abnormal imaging
Aaron M Lewis1, Melissa Yu, Stephen J DeArmond
1Department of Neurology, University of California, San Francisco, USA.
Background:
Although more than 160 cases of iatrogenic Creutzfeldt-Jakob disease (iCJD) from human growth hormone (hGH) treatment have been documented, to our knowledge abnormal cerebellar findings on magnetic resonance imaging (MRI) have not been reported.
Objective:
To report a case of hGH-related iCJD with abnormal cerebellar MRI findings on fluid-attenuated inversion recovery (FLAIR) and diffusion-weighted MRI (DWI).
Design:
Case report.
Setting:
Outpatient neurology clinic at a university medical center.
Patient:
A 33-year old man who had subacute gait ataxia and blurred vision.
Results:
Beginning 19 years prior, this patient had received cadaveric pituitary-derived hGH treatment for at least 5 years. Magnetic resonance imaging revealed FLAIR and DWI abnormalities, particularly in the cerebellum. He died 7 months after disease onset of autopsy-confirmed iCJD. Pathological changes corresponded largely to MRI findings.
Conclusions:
To our knowledge, this is the first case of hGH-related iCJD with FLAIR and DWI abnormalities within the cerebellum. As symptoms referable to the cerebellum occur early in iCJD, it suggests that these MRI sequences may allow earlier diagnosis of this form of prion disease.
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