A Woman With Eosinophilic Brainstem Meningoencephalitis

Abstract

A previously healthy 25-year-old woman presented with headache, dysarthria, double vision, and dizziness for 1 week. She denied any history of fever, head trauma, vomiting, diarrhea, abdominal pain, or cough. She had traveled to northeastern Brazil 2 months before the onset of the neurological symptoms.On examination, she had a mild right-side hemiparesis with hyperreflexia and hemiataxia. She could walk unassisted but presented with a broad base. There were no meningeal signs. She did not present with hepatosplenomegaly of lymphadenopathy. Her cranial magnetic resonance imaging showed a T2-weighted fluid-attenuated inversion recovery hyperintense lesion with heterogeneous gadolinium enhancement in the pons (Figure). There were no signs of diffusion restriction on diffusion-weighted imaging or hemorrhages on susceptibility-weighted imaging.The laboratory test results showed a hemoglobin level of 15.3 g/dL (to convert to grams per liter, multiply by 10.0), total leukocyte count of 10 390/uL (to convert to ×10 9 /L, multiply by 0.001), of which 1703 (16.4%) were eosinophils, and a platelet count of 284 000/μL (to convert to ×10 9 /L, multiply by 0.001). The patient's liver and kidney function test results were normal. Computed tomography of the chest revealed bilateral patchy pulmonary infiltrates.Cerebrospinal fluid (CSF) analysis showed 640 cells, of which 57% were lymphocytes, 26% were eosinophils, and 13% were monocytes; protein levels were 70 mg/dL, and glucose levels were 46 mg/dL. Her blood cultures were found to be sterile.