Although there are several case reports of progressive multifocal leukoencephalopathy (PML) in multiple myeloma (MM), there are few reports of cases associated with pomalidomide. Here, we report the case of a 69-year-old female who had received 41 cycles of pomalidomide and dexamethasone treatment for relapsed/refractory IgG-κ MM presented with right-hand weakness; she was diagnosed as pomalidomide-associated PML. Fluid-attenuated inversion recovery (FLAIR) on admission showed high signals in the bilateral front-parietal lobe white matter, with multiple punctate lesions in the vicinity of the main lesions. These punctate pattern findings on FLAIR were similar to that of natalizumab-associated PML. Susceptibility weighted imaging (SWI) showed hypointense rims within the cortex at unaffected sites, in the initial stages. Subsequently, the clinical manifestations deteriorated, and the FLAIR images showed new hyperintense white matter lesions at the sites where cortical SWI hypointense rims were detected on the initial MRI examination. Our patient's serial MRI findings suggest that cortical SWI hypointense rims appear prior to the visible demyelinating white matter lesions in patients with PML.

中文翻译：

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多发性骨髓瘤中与Pomalidomide相关的进行性多灶性白质脑病：在临床恶化之前，皮层磁化率加权成像低点发现。

尽管在多发性骨髓瘤（MM）中有数例进行性多灶性白质脑病（PML）的病例报道，但与泊马利度胺相关的病例报道却很少。在这里，我们报道了一名69岁女性，该患者接受了41个疗程的pomalidomide和地塞米松治疗复发/难治性IgG-κMM并伴有右手无力的情况。她被诊断为与波马利度相关的PML。入院时减液型反转恢复（FLAIR）在双侧前顶叶白质中显示高信号，在主要病变附近有多个点状病变。这些在FLAIR上的点状模式发现与那他珠单抗相关的PML相似。在初始阶段，药敏加权成像（SWI）显示皮质内低位边缘在未受影响的部位。后来，临床表现恶化，FLAIR图像显示在最初的MRI检查中在检测到皮质SWI低点边缘的部位出现了新的高强度白质病变。我们患者的一系列MRI发现表明，在PML患者中，在可见的脱髓鞘性白质病变之前出现了皮质SWI低点边缘。