Fat embolism syndrome complicates open fractures involving long bones, although it occasionally follows nontraumatic conditions. Incomplete forms of the syndrome (ie, cerebral fat embolism) represent a challenge to diagnosis, and brain MRI represents a valuable diagnostic tool. We describe a patient who had a fat embolism to the brain after an isolated traumatic open fracture of the tibia. MRI with T2 and diffusion-weighted images revealed multiple, reversible brain lesions, suggesting vasogenic edema and consistent with this entity. At present, MR imaging is the most sensitive technique to evaluate cerebral fat embolism.
We report a possible association between ruxolitinib and JC virus meningitis. A 72-year-old man with myelofibrosis started treatment with ruxolitinib. Fourteen days later, the patient presented to the emergency department with fever and nausea. HIV test was negative. Ruxolitinib was suspended. Symptoms progressed with neck stiffness, cognitive impairment, and motor aphasia. CSF was positive for JC virus. MRI showed nonspecific abnormal findings. Five days after the clinical debut, the patient died. The clinical picture, MRI imaging, and positive JC virus PCR in CSF strongly suggest ruxolitinib-related JC virus meningitis.
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