1 - PediatricInfectiousDiseasesUnit, Hospital Dona Estefânia, Centro Hospitalar e Universitário de Lisboa Central, Lisbon.
2 - PediatricInfectiousDiseasesUnit, Hospital Dona Estefânia, Centro Hospitalar e Universitário de Lisboa Central, Lisbon.
3 - NeuroradiologyDepartment, Hospital Dona Estefânia, Centro Hospitalar e Universitário de Lisboa Central, Lisbon.
4 - PediatricNeurologyUnit, Hospital Dona Estefânia, Centro Hospitalar e Universitário de Lisboa Central, Lisbon.
5 - PediatricInfectious DiseasesUnit, Hospital Dona Estefânia, Centro Hospitalar e Universitário de Lisboa Central, Lisbon.
- Excellence in Pediatrics, Prague. Oral presentation
Resumo:
Introduction: Encephalitis is an inflammation of the brain that can have numerous etiologies, both infectious and non-infectious, with similar presentation. Mycoplasma pneumoniae is a frequent agent for respiratory disease, although extrapulmonary complications are not uncommon, but encephalitis is rare in children. Many of these nonrespiratory disorders are postulated to be the result of immune reactions, as well as of direct lesions.
Case Description: Previously healthy15-year old male, presented with odynophagia, headache, vomiting and fever 7 days before evolving to altered mental status (Glasgow 13) and worsening of his general condition. He was admitted with the clinical diagnosis of meningoencephalitis, under acyclovir, ceftriaxone and ciprofloxacin. The EEG and Head-CT scan were normal but the cerebrospinal fluid demonstrated a pleocytosis (53,0/μL) with predominant mononuclear cells, normal glucose levels and mildly elevated protein levels (50,5 mg/dL). The lumbar puncture opening pressure was 23 cmH2O. There was intrathecal synthesis of immunoglobulins (Link-Tibbling index elevated for IgG and IgM). Positive PCR in respiratory secretions and serology for Mycoplasma pneumoniae in serum (IgM and IgG) were positive in blood, but negative in cerebrospinal fluid. Ten days after the onset of this disease, he developed a paralysis of the VI cranial nerve, with convergent strabismus of the right eye and diplopia. The Head-MRI demonstrated a T2 and FLAIR hypersignal of the pyramidal tracts bilaterally and of the parietal and cerebellar white matter, which evoked a demyelinating disease. He underwent treatment with daily pulses of methylprednisolone for 5 days, and evolved favorably, with complete resolution of clinical symptoms and signs.
Conclusion: Mycoplasma pneumoniae is able to invade the central nervous system, however failure to detect it from cerebrospinal fluid by serology or PCR in the diagnosis of mycoplasma encephalitis has been reported. This opens the discussion about the direct pathogen invasion versus immune mediated lesions that has implications in treatment options.
PalavrasChave: Children, Encephalitis, Mycoplasma pneumoniae