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. 2022 Feb 25;9:2329048X221079093. doi: 10.1177/2329048X221079093

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© The Author(s) 2022

This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).

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Figure 1. — A: Initial MRI showing bilateral T2 FLAIR hyperintensities throughout concerning for ADEM. Figure 1B: Repeat MRI obtained during second hospitalization (day 26) showing worsening lesion burden with more extensive T2 FLAIR hyperintensities throughout. Figure 1C: New T2 FLAIR lesions seen on MRI during third hospitalization (day 70) after second dose of rituximab. Figure 1D: Repeat MRI obtained during maintenance therapy with alternating IVIg and IVMP therapy on day 160 showing large tumefactive lesion in superior and middle frontal gyrus. Figure 1E: Routine surveillance MRI obtained 1 year after disease onset, after spacing of IVIg therapy, showing hyperintensities spanning a large portion of the left hemisphere. Figure 1F: New T2 FLAIR hyperintensities seen after IVIg was discontinued and patient was maintained solely on monthly tocilizumab monotherapy.