Striatal hypermetabolism on 18FDG-PET scan is a neuroradiological finding that has been described in association with autoimmune disorders such as Sydenham chorea, lupus or antiphospholipid syndrome. Here, we report three patients with non-paraneoplastic limbic encephalitis characterized by 18FDG-PET hypermetabolism of both striata, in contrast with diffuse hypometabolism in the rest of the brain. All patients developed subacute dementia, and antibodies to voltage-gated potassium channels were found in all cases. Brain metabolism and neurological status improved within a few months of immunosuppressive therapy. The finding of striatal hypermetabolism on 18FDG-PET images could thus be highly indicative of limbic encephalitis associated with anti-neuropil antibodies. It could be of significant help in the diagnosis of this rare and treatable condition, and may also provide a useful marker of disease outcome.

We report one case of acquired sideroblastic anaemia in a patient treated for Wilson's disease with triethylene tetramine dihydrochloride (TTH). No other cause of acquired sideroblastic anaemia was found, and neither iron nor pyridoxine therapy could correct this anaemia. In contrast, decreasing the dose of TTH led to disappearance of ringed sideroblasts. Thus TTH should be added as a further cause of secondary acquired sideroblastic anaemia. The pathophysiology of this finding, probably linked to an abnormality of mitochondrial iron metabolism, is briefly discussed.

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In the presence of acute neuropsychiatric disorders with a negative etiologic research, physician should think about dysimmune encephalitis. Facio-brachial dystonic seizures and syndrome of inappropriate antidiuretic hormone secretion are highly evocative of anti-leucine rich glioma inactivated 1 encephalitis. The diagnosis needs specific diagnostic tests (cerebral (18)FDG position emission tomography and antibodies research in cerebro-spinal fluid and in serum), after the exclusion of alternative diagnoses. Extensive and repeated diagnostic work-up for neoplasia is required. Immunosupressive therapies are effective in most cases.

Hagino H. Three cases ofosteoinalacia caused by intravenoub administration of saccharaied ferrlc oxide. Seikeigeka Saigaigeka 3:l 182-1 185. 1990. 4. Mizumoto H, ltota A. Mashio Y, Tauji T. Takakahashi H: A case ot osteoiiialacin caused by intravcnous administration of saccharaicd fcrric oxidc. Naika 65593-596. 1990. 5 . Okada M. lida M. Iniamura K, Turuta 0. Egashira Y, Murakami M. Oogushi H. Matui T, Omae T: Elfecr of intravenous infusion of saccharated fcrric oxide in hypophosphatemia. Igakunoayumi I 17:21-24. 19x1 Trilineage Response to Recombinant Human Granulocyte Colony-Stimulating Factor Administration in a Patient With Myelodysplastic Syndrome To /he Editor; Washizuka et al. [ I I recently reported a patient with myelo-dysplaatic syndrome who exhibited a significant increase in granulocyte as well as in erythrocyte and platelet counts after administration of recombinant human granulocyte colony-stimulating factor (rHuG-CSF). We report il similar case An 18-year-old man was admitted in February, 1990, for evaluation of pallor and fatigue. Results of blood tests were as follows: hemoglobin 6.5 gidl. mean corpuscular volume (MCV) I16 tl, reticulocytes 35 x 1OY/liter; white blood cells 3.9 X 10qiliter with 34% neutrophils, 2% eosinophils, 59% lymphocytes, and 5% monocytes: platelets 61 X 10y/liter. The bone marrow cellularity was increased, with 49%> granulocytes, 4 1 % erythroblasts, and megakaryocytes within the normal range: dyserythropoiesis was observed, with macro-and niegaloblasts, intranuclear chromatin, and intercytoplasmic bridges, binucleated erythrohlasts. and Howell-Jolly bodies together with an excess of inyeloblasts (13%). Sixty-seven percent of erythrohlasts contained iron after Perk staining, but no ring sideroblastc were found. Fetal hemoglobin (HbF) level was 7.710. The patient was diagnosed with refractory anemia with exceqs blasts (RAEB) according to FAB classification. Cytogenetic examination showed a normal marrow kayotype in 100% of 40 metdphases analyzed. Due to the absence of a histocompatible sibling. search for an unrelated bone marrow donor was initiated.During the first year from diagnosis, severe anemia required multiple kransfusions (three or four red blood cell concentrates per month); platelet counts ranged between 40 and 60 X IO'iliter, and neutrophils were stable at -I X 10y/liter. After an infection in February, 1991, subcutaneous rHuG-CSF (Lenograstim) was started at an initial dose of 5 pg/kg/day. reduced after I month to 5 kglkgievery other day for I year and subsequently to 5 psikg twice per week. As is shown in Figure I , a rise in neutrophils to normal values occurred within the first days of treatment and was steadily maintained. Moreover, a response was also observed in erythroid and inegakaryocytic lineages: The patient became transfusion independent I month after onset of rHuG-CSF administration, while platelet counts rose gradually to normal values within 5 months and were maintained thereafter. Bone marrow examination after 10 months of rHuG-CSF therapy disclo...