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...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2017-01-01
|
| Series: | Case Reports in Critical Care |
| Online Access: | http://dx.doi.org/10.1155/2017/1092537 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832554087840743424 |
|---|---|
| author | Pedro Gaspar-da-Costa Sofia Reimão Sandra Braz João Meneses Santos Rui M. M. Victorino |
| author_facet | Pedro Gaspar-da-Costa Sofia Reimão Sandra Braz João Meneses Santos Rui M. M. Victorino |
| author_sort | Pedro Gaspar-da-Costa |
| collection | DOAJ |
| 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 | Article |
| id | doaj-art-635db93a206840e7864fd229e08074e2 |
| institution | Kabale University |
| issn | 2090-6420 2090-6439 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Critical Care |
| spelling | doaj-art-635db93a206840e7864fd229e08074e22025-02-03T05:52:19ZengWileyCase Reports in Critical Care2090-64202090-64392017-01-01201710.1155/2017/10925371092537Disseminated Necrotizing Leukoencephalopathy Complicating Septic Shock in an Immunocompetent PatientPedro Gaspar-da-Costa0Sofia Reimão1Sandra Braz2João Meneses Santos3Rui M. M. Victorino4Department of Internal Medicine, Hospital de Santa Maria and Faculty of Medicine of Lisbon, Lisbon, PortugalDepartment of Neurologic Imaging, Hospital de Santa Maria and Faculty of Medicine of Lisbon, Lisbon, PortugalDepartment of Internal Medicine, Hospital de Santa Maria and Faculty of Medicine of Lisbon, Lisbon, PortugalDepartment of Internal Medicine, Hospital de Santa Maria and Faculty of Medicine of Lisbon, Lisbon, PortugalDepartment of Internal Medicine, Hospital de Santa Maria and Faculty of Medicine of Lisbon, Lisbon, PortugalDisseminated 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.http://dx.doi.org/10.1155/2017/1092537 |
| spellingShingle | Pedro Gaspar-da-Costa Sofia Reimão Sandra Braz João Meneses Santos Rui M. M. Victorino Disseminated Necrotizing Leukoencephalopathy Complicating Septic Shock in an Immunocompetent Patient Case Reports in Critical Care |
| 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 |
| url | http://dx.doi.org/10.1155/2017/1092537 |
| work_keys_str_mv | AT pedrogaspardacosta disseminatednecrotizingleukoencephalopathycomplicatingsepticshockinanimmunocompetentpatient AT sofiareimao disseminatednecrotizingleukoencephalopathycomplicatingsepticshockinanimmunocompetentpatient AT sandrabraz disseminatednecrotizingleukoencephalopathycomplicatingsepticshockinanimmunocompetentpatient AT joaomenesessantos disseminatednecrotizingleukoencephalopathycomplicatingsepticshockinanimmunocompetentpatient AT ruimmvictorino disseminatednecrotizingleukoencephalopathycomplicatingsepticshockinanimmunocompetentpatient |