A Girl of Unusual Diffuse White Matter and Basal Ganglia Lesions Following Streptococcus Pneumoniae Meningoencephalitis
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Acute bacterial meningitis such as Streptococcus pneumoniae (S. pneumonia) continues to be a major cause of morbidity and mortality in both children and adults. A rapid aggravating invasion of diffuse white matter following bacterial meningoencephalitis may be a rare occurrence depending on patient’s immune response. A 6-month-old girl was referred to our hospital after 3-days of fever and appeared lethargic at the time of visit. Lumbar puncture was performed with the results of white blood cells of 60/mm3 (70% neutrophil), total protein 415 mg/dL, and glucose 51 mg/dL. Brain MRI showed very widely spreading signal abnormalities of diffuse white matters, basal ganglia and corpus callosum. Intravenous vancomycin and high dose cefotaxime as well as intravenous immunoglobulin (0.4 g/kg/day for 5 days), and high-dose methylprednisolone (30 mg/kg/day) were started on the first and third day after admission, respectively. On the 4th day after admission, the patient was intubated for ventilator care and despite aggressive treatment, the patient deteriorated rapidly and died after 60 days since admission. S. pneumoniae growth was noted from both blood and cerebrospinal fluid. We report this case with rapidly aggravating white matter lesion due to S. pneumoniae meningoencephalitis, as one of the youngest patient reported to date, with a fatal outcome.
Abstract
Acute bacterial meningitis such as Streptococcus pneumoniae (S. pneumonia) continues to be a major cause of morbidity and mortality in both children and adults. A rapid aggravating invasion of diffuse white matter following bacterial meningoencephalitis may be a rare occurrence depending on patient’s immune response. A 6-month-old girl was referred to our hospital after 3-days of fever and appeared lethargic at the time of visit. Lumbar puncture was performed with the results of white blood cells of 60/mm3 (70% neutrophil), total protein 415 mg/dL, and glucose 51 mg/dL. Brain MRI showed very widely spreading signal abnormalities of diffuse white matters, basal ganglia and corpus callosum. Intravenous vancomycin and high dose cefotaxime as well as intravenous immunoglobulin (0.4 g/kg/day for 5 days), and high-dose methylprednisolone (30 mg/kg/day) were started on the first and third day after admission, respectively. On the 4th day after admission, the patient was intubated for ventilator care and despite aggressive treatment, the patient deteriorated rapidly and died after 60 days since admission. S. pneumoniae growth was noted from both blood and cerebrospinal fluid. We report this case with rapidly aggravating white matter lesion due to S. pneumoniae meningoencephalitis, as one of the youngest patient reported to date, with a fatal outcome.
참고문헌 (20)
- Kastenbauer S, "Pneumococcal meningitis in adults: spectrum of complications and prognostic factors in a series of 87 cases", Brain, 126, pp.1015~1025 (2003)
- Taft TA, "Cerebral infarction in Hemophilus influenzae type B meningitis", Clin Pediatr (Phila), 25, pp.177~180 (1986)
- 엄태민, "소아 세균수막염에서 경막하삼출 합병증의 임상적 특징", 대한소아신경학회지, 20(3), pp.137~143 (2012), 대한소아신경학회
- Chandran A, "Long-term sequelae of childhood bacterial meningitis: an underappreciated problem", Pediatr Infect Dis J, 30, pp.3~6 (2011)
- Jorens PG, "Meningoencephalitis caused by Streptococcus pneumoniae: a diagnostic and therapeutic challenge. Diagnosis with diffusionweighted MRI leading to treatment with corticosteroids", Neuroradiology, 47, pp.758~764 (2005)
- Jorens PG, "Streptococcus pneumoniae meningoence phalitis with unusual and widespread white matter lesions", Eur J Paediatr Neurol, 12, pp.127~132 (2008)
- Herson VC, "Prediction of morbidity in Hemophilus influenzae meningitis", Pediatrics, 59, pp.35~39 (1977)
- Koomen I, "Hearing loss at school age in survivors of bacterial meningitis: assessment, incidence, and prediction", Pediatrics, 112, pp.1049~1053 (2003)
- Roine I, "Ataxia and its association with hearing impairment in childhood bacterial meningitis", Pediatr Infect Dis J, 34, pp.809~813 (2015)
- Feldman WE, "Relation of concentrations of Haemophilus influenzae type b in cerebrospinal fluid to late sequelae of patients with meningitis", J Pediatr, 100, pp.209~212 (1982)
- Thigpen MC, "Bacterial meningitis in the United States, 1998- 2007", Engl J Med, 364, pp.2016~2025 (2011)
- Arditi M, "Three-year multicenter surveillance of pneumococcal meningitis in children: clinical characteristics, and outcome related to penicillin susceptibility and dexamethasone use", Pediatrics, 102, pp.1087~1097 (1998)
- Wanibuchi M, "A case of Streptococcus pneumoniae meningitis showing a marked contrast enhancement effect of whole arachnoid membrane on MRI", Comput Med Imaging Graph, 24, pp.407~411 (2000)
- Chatterjee T, "Pneumococcal meningitis masquerading as subarachnoid haemorrhage", Med J Aust, 178, pp.505~507 (2003)
- Abe M, "Purulent meningitis with unusual diffusion-weighted MRI findings", Eur J Radiol, 44, pp.1~4 (2002)
- Yiş U, "Brain magnetic resonance imaging findings suggestive of widespread white matter involvement in children with Streptococcus mitis meningitis", Turk J Pediatr, 54, pp.425~428 (2012)
- van der Knaap MS, "Vanishing white matter disease", Lancet Neurol, 5, pp.413~423 (2006)
- Gomes JA, "Glucocorticoid therapy in neurologic critical care", Crit Care Med, 33, pp.1214~1212 (2005)
- Barkovich AJ, "Normal maturation of the neonatal and infant brain: MR imaging at 1.5 T", Radiology, 166, pp.173~180 (1988)
- Chugani HT, "Positron emission tomography study of human brain functional development", Ann Neurol, 22, pp.487~497 (1987)