A lumbar puncture revealed a normal CSF biochemistry analysis, no cells, no CSF culture proliferation, and a negative CSF herpes simplex type 1,2 PCR and cytomegalovirus PCR, and oligoclonal
Intrathecal antibody synthesis was demonstrated by testing for oligoclonal
bands (isoelectric focusing and immunofixation of IgG parallel in serum and CSF) and by calculation of the IgM, IgA, and IgG index (ratio between CSF and serum immunoglobulin class after correcting for albumin concentrations in the CSF and serum).
All patients presented oligoclonal
bands of IgG type 2 or 3 in CSF.
Cerebrospinal fluid analysis was unremarkable, with normal protein, glucose, no oligoclonal
bands and no pleocytosis.
Additional features that suggest adrenal insufficiency, absence of oligoclonal
bands in CSF should prompt to investigate very long chain fatty acids for ALD diagnosis (5).
Polymerase chain reaction (PCR) for herpes simplex virus (HSV) type I and II was negative, as well as oligoclonal
Adult T-cell leukemia/lymphoma (ATL) is a malignant neoplasm of T-lymphocytes caused by human T-cell lymphotropic virus type 1 (HTLV-1); it is characterized by mono- or oligoclonal
integration of proviral deoxyribonucleic acid (DNA) and the presence of abnormal lymphocytes with convoluted nuclei (1-5).
In addition, detection of an oligoclonal
band in the cerebrospinal fluid analysis supports intrathecal immunoglobulin synthesis (12).
bands were detected in CSF (pattern 2) and immunoglobulin G index was 0.68 (<0.85).
"The most important addition is that the new criteria allow MS diagnosis when the MRI scan meets criteria for DIS and unique oligoclonal
bands (OCB) are present in [cerebrospinal fluid], even in absence of DIT on the MRI scan," the researchers wrote.
Lisa's spinal fluid was collected during a lumbar puncture and revealed oligoclonal
bands and an elevated IgG index.