Miliary Brain Metastasis with Perivascular Enhancement in ALK-Positive Lung Cancer: A Rapid Recovery after Concurrent Lorlatinib and Whole-brain Radiotherapy.

Authors

Toru Kuratomi, Shinjiro Sakamoto, Maho Inoue, Kiyofumi Shimoji, Kakuhiro Yamaguchi, Yasushi Horimasu, Takeshi Masuda, Taku Nakashima, Hironobu Hamada, Hiroshi Iwamoto

Published in

Internal medicine (Tokyo, Japan). Sep 29, 2026. Epub Sep 29, 2026.

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.

PMID:
42816387
Bibliographic data and abstract were imported from PubMed on 01 Oct 2026.

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