Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) after treatment for Hodgkin's lymphoma

Int J Hematol. 2015 Dec;102(6):709-12. doi: 10.1007/s12185-015-1850-9. Epub 2015 Aug 5.

Abstract

Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is a rare central nervous system (CNS) disorder with distinct radiological features. However, CLIPPERS may mimic CNS lymphoma, and several cases in which CLIPPERS occurred premonitory to CNS lymphoma have been reported. We report a 31-year-old man presenting with progressive gait ataxia and the characteristic MRI features of CLIPPERS. He was diagnosed with stage II Hodgkin's lymphoma at the age of 15, and we considered the possibility of newly emerged CNS lymphoma occurring in the immunosuppressive condition after the treatment of Hodgkin's lymphoma. Histological findings showed no evidence of CNS lymphoma and the neurological symptoms were resolved by steroids. Although CLIPPERS developed in the reverse order in this case, CLIPPERS should be considered in different diagnosis for CNS lymphoma.

Keywords: Brain biopsy; CLIPPERS; CNS lymphoma; MRI.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Biopsy
  • Central Nervous System Neoplasms / drug therapy
  • Chronic Disease
  • Cyclophosphamide / administration & dosage
  • Diagnosis, Differential
  • Encephalitis / diagnosis*
  • Encephalitis / drug therapy*
  • Encephalitis / pathology
  • Hodgkin Disease / drug therapy
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Neuroimaging
  • Pons / pathology*
  • Prednisolone / administration & dosage*
  • Prednisone / administration & dosage
  • Procarbazine / administration & dosage
  • Treatment Outcome
  • Vincristine / administration & dosage

Substances

  • Procarbazine
  • Vincristine
  • Cyclophosphamide
  • Prednisolone
  • Prednisone

Supplementary concepts

  • COPP protocol