We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Comment & Response |

Should CLIPPERS Be Considered a Prelymphoma State or a New Inflammatory Disease?

Guillaume Taieb, MD1; Dimitri Renard, MD1; Pierre Labauge, MD, PhD1
[+] Author Affiliations
1Department of Neurology, CHU Nîmes, Hôpital Caremeau, Place du Pr Debré, 30029 Nîmes, Cedex, France
JAMA Neurol. 2013;70(9):1200-1201. doi:10.1001/jamaneurol.2013.3652.
Text Size: A A A
Published online


To the Editor We read with interest the clinical observation titled “Fatal B-cell lymphoma following chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids [CLIPPERS].”1 The patient presented with steroid-responsive brainstem attacks compatible with CLIPPERS. Biopsy findings showed characteristic perivascular lymphohistiocytic infiltrates with T-lymphocyte predominance. During the third attack, magnetic resonance imaging revealed an atypical enhancing pontine lesion. Treatment with steroids and rituximab led to slight transient clinical improvement, followed by rapidly progressive worsening with brainstem herniation and death. Also during the third attack, new biopsy findings disclosed large atypical B lymphocytes positive for Epstein-Barr virus (EBV)–encoded RNA, leading to a final diagnosis of lymphomatoid granulomatosis (LYG).


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





September 1, 2013
Hjalmar J. De Graaff, BSc; Mike P. Wattjes, MD, PhD; Annemieke J. Rozemuller, MD, PhD; Axel Petzold, MD, PhD; Joep Killestein, MD, PhD
1MS Center Amsterdam, Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands
2MS Center Amsterdam, Department of Radiology, VU University Medical Center, Amsterdam, the Netherlands
3Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
JAMA Neurol. 2013;70(9):1201. doi:10.1001/jamaneurol.2013.3855.
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

3 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Related Collections