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Case Reports
. 2016 Jun;6(3):e24-e26.
doi: 10.1212/CPJ.0000000000000220.

Tocilizumab-associated multifocal cerebral thrombotic microangiopathy

Paul Jewell  1 , Olaf Ansorge  1 , Wilhelm Kuker  1 , Sarosh R Irani  1 , Giovanna Zamboni  1
Affiliations
Case Reports

Tocilizumab-associated multifocal cerebral thrombotic microangiopathy

Paul Jewell et al. Neurol Clin Pract. 2016 Jun.
No abstract available

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Figures

Figure.
Figure.. Radiologic and histopathologic features
(A–D) Cerebral MRI performed 4 days after presentation. (A, B) Coronal views from the T2-weighted fluid-attenuated inversion recovery (FLAIR) MRI show lesions in the left thalamus, cingulate gyri, left medial temporal lobe, brainstem, and right parietal lobe. (C) Axial view from the gradient echo sequence shows hemorrhagic transformation with hemosiderin deposition in the lesions. (D) Axial view from diffusion-weighted imaging shows restricted diffusion in some of the lesions. Red arrows point to the biopsied right parietal lesion. (E–G) Cerebral biopsy, serial sections (×400 magnification), demonstrate thrombotic microangiopathy with petechial hemorrhages and edematous white matter. (E) Hematoxylin & eosin stain. Note microhemorrhage on right, edema, and a small-caliber cerebral vessel with a fibrinoid bright eosinophilic thrombus (left), which is highlighted in (F) with immunohistochemistry against CD31, expressed on thrombocytes (brown intravascular reaction product). (G) CD68 immunohistochemistry highlights scattered perivascular and parenchymal activated microglia and macrophages (brown reaction product).
See this image and copyright information in PMC

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