Dados do Trabalho

Título

CLIPPERS: CASE REPORT

RESUMO

M.S.M., male, 33 years old, was admitted in January 2022 with a report of gait impairment for 4 years, worsening in the last year, associated with imbalance. He also presented, in the last month, blurred vision, diplopia, and slurred speech. On physical examination, he presented with a global strength grade of 4+, all reflexes exalted, and ataxic gait.
At the time of admission, a new brain MRI was made with pons lesions, with a salt and pepper aspect, suspected of inflammatory disease, being opted for pulse therapy with corticosteroids and plasmapheresis, with clinical and radiological improvement.
Discussion
Chronic lymphocytic inflammation with steroid-responsive pontine perivascular enhancement is an inflammatory disease of the central nervous system defined in 2010 by Pittock, who described the case of 8 patients with similar clinical, radiological, and pathological features who were responsive to corticosteroids.
For the diagnosis of CLIPPERS is necessary that the patient presents clinical alterations like progressive subacute ataxia and diplopia and symptoms related to brainstem involvement. Associated with MRI alteration with multiple salt and pepper sign in pons, with or without propagation to cerebellar peduncles and cerebellum. Histopathologically presenting a perivascular lymphohistiocytic infiltrate of the white matter, with a predominance of CD3 and CD4 lymphocytes. It´s possible to make a definitive diagnosis only with clinical and image characteristics, if other etiologies are excluded.
Final considerations
CLIPPERS is a rare disease with a high morbidity rate, with a high risk of complications and disability when not diagnosed and treated at the right time, so it is important to know the pathology and make a diagnosis to offer the best treatment to the patient.

Palavras Chave

CLIPPERS, corticosteroids, inflammatory