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Fever and neutropenia developed in a 14-year-old girl after she received intensive chemotherapy for her third relapse of pre–B-cell acute lymphocytic leukemia, including intrathecal therapy with methotrexate, cytarabine, and prednisone. She had headache, nausea, and photophobia and became increasingly confused and somnolent; a chest radiograph showed an interstitial pattern. A T2-weighted magnetic resonance imaging (MRI) scan of her skull (with fluid-attenuated inversion recovery) showed high-signal lesions involving all basal ganglia except the thalami (Panel A). The cerebrospinal fluid protein level was markedly increased. A polymerase-chain-reaction assay for Mycoplasma pneumoniae in cerebrospinal fluid was negative. Although the serum IgM antibody . . . [Full Text of this Article] |
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