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CASE REPORT
Marchiafava-Bignami disease with haemophagocytic lymphohistiocytosis as a postoperative complication of cardiac surgery
  1. Kentarou Takei1,
  2. Naotaka Motoyoshi2,
  3. Kazuhiro Sakamoto3 and
  4. Tetsuyuki Kitamoto4
  1. 1 Neurology, Osaki Citizen Hospital, Osaki, Miyagi, Japan
  2. 2 Cardiovascular Surgery, Osaki Citizen Hospital, Osaki, Japan
  3. 3 Pathology, Osaki Citizen Hospital, Osaki, Japan
  4. 4 Neurological Science, Tohoku University School of Medicine, Sendai, Miyagi, Japan
  1. Correspondence to Dr Kentarou Takei, kentarouhop{at}hotmail.co.jp

Abstract

Marchiafava-Bignami disease (MBD) is a rare complication of chronic alcoholism; however, MBD in a non-alcoholic diabetic patient has rarely been reported. The aetiology or pathophysiology of MBD is still unknown. A 50-year-old man with a history of untreated diabetes mellitus underwent on-pump beating coronary artery bypass graft surgery (CABG) surgery for three-vessel and left main coronary disease. 3 days after the surgery, he developed a fever over 40°C and entered a coma state. MRI revealed multiple lesions, including in the corpus callosum, globus pallidus, brain stem and upper cervical spinal cord, which suggested MBD. The patient did not respond to thiamine therapy, but partly responded to steroid therapy. He ultimately died of respiratory failure. The autopsy revealed MBD and haemophagocytic lymphohistiocytosis. It is rare, but systemic inflammatory response syndrome induced by on-pump beating CABG could develop these complication.

  • neurology
  • cardiothoracic surgery
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Footnotes

  • Contributors NM performed an operation. KT took care of the patient, evaluated data and drafted the manuscript. KS and TK performed an autopsy and were in charge in pathological assessment.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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