Miliary Brain Metastasis with Perivascular Enhancement in ALK-Positive Lung Cancer: A Rapid Recovery after Concurrent Lorlatinib and Whole-brain Radiotherapy
Abstract
Miliary brain enhancement presents a broad differential diagnosis, and its combination with perivascular enhancement (PVE) suggests inflammatory or infectious conditions. We herein report the case of a 30-year-old man with ALK-positive lung adenocarcinoma who developed progressive nausea and impaired consciousness during corticosteroid therapy. Brain magnetic resonance imaging revealed miliary brain enhancement with PVE, initially suggesting infection; however, the cerebrospinal fluid and laboratory findings were negative. Brain metastases were suspected. Concurrent lorlatinib and whole-brain radiotherapy resulted in rapid clinical and radiological improvements. Metastatic disease should be considered in cases presenting with miliary brain enhancement and PVE, even when inflammatory or infectious conditions are suspected.
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BibTeX
@article{kuratomi2026miliary,
title = {{Miliary Brain Metastasis with Perivascular Enhancement in ALK-Positive Lung Cancer: A Rapid Recovery after Concurrent Lorlatinib and Whole-brain Radiotherapy}},
author = {Toru Kuratomi and Shinjiro Sakamoto and Maho Inoue and Kiyofumi Shimoji and Kakuhiro Yamaguchi and Yasushi Horimasu and Takeshi Masuda and Taku Nakashima and Hironobu Hamada and Hiroshi Iwamoto},
journal = {Internal Medicine},
year = {2026},
month = sep,
doi = {10.2169/internalmedicine.7704-26},
url = {https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_7704-26/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Miliary Brain Metastasis with Perivascular Enhancement in ALK-Positive Lung Cancer: A Rapid Recovery after Concurrent Lorlatinib and Whole-brain Radiotherapy
AU - Toru Kuratomi
AU - Shinjiro Sakamoto
AU - Maho Inoue
AU - Kiyofumi Shimoji
AU - Kakuhiro Yamaguchi
AU - Yasushi Horimasu
AU - Takeshi Masuda
AU - Taku Nakashima
AU - Hironobu Hamada
AU - Hiroshi Iwamoto
PY - 2026
DA - 2026/09/29
JO - Internal Medicine
DO - 10.2169/internalmedicine.7704-26
UR - https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_7704-26/_article
AB - Miliary brain enhancement presents a broad differential diagnosis, and its combination with perivascular enhancement (PVE) suggests inflammatory or infectious conditions. We herein report the case of a 30-year-old man with ALK-positive lung adenocarcinoma who developed progressive nausea and impaired consciousness during corticosteroid therapy. Brain magnetic resonance imaging revealed miliary brain enhancement with PVE, initially suggesting infection; however, the cerebrospinal fluid and laboratory findings were negative. Brain metastases were suspected. Concurrent lorlatinib and whole-brain radiotherapy resulted in rapid clinical and radiological improvements. Metastatic disease should be considered in cases presenting with miliary brain enhancement and PVE, even when inflammatory or infectious conditions are suspected.
SN - 1349-7235
SN - 0918-2918
ER -