A Case of Japanese Encephalitis Presenting with Fever and Seizure in a 7-month old Infant
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Japanese encephalitis is one of the leading causes of acute encephalitis in Asia. But in Korea, the number of Japanese encephalitis cases has dropped considerably due to mass vaccination and vector control. Especially, there were no case reports under the age of 9 years during the last ten years. We will describe a case of a previously healthy 7-month old boy who presented with fever and seizure. The patient was diagnosed with Japanese encephalitis, based on the cerebrospinal fluid and serum antibody analyses for the Japanese encephalitis virus. Typical brain magnetic resonance image findings of Japanese encephalitis were observed. The patient received extensive conservative treatment including high dose intravenous corticosteroid treatment and immunoglobulin. In spite of severe hemodynamic instability, the patient survived, and he is currently in a vegetative state with respiratory assist by a home ventilator. Although the incidence of Japanese encephalitis dropped dramatically in Korea, pediatricians should always consider the diagnosis as one of the possibilities for patients with encephalitis, especially if the patient is not immunized for JEV. Since there is no specific treatment for JEV, timely and comprehensive conservative care is critical to reduce the mortality and morbidity.
Abstract
Japenses encephalitis (JE)는 동아시아에서 가장 흔한 뇌염의 원인 중 하나이며 사망률과합병증발생률이 높은 질환이다. 그러나 최근 국내에서는국가차원의 예방접종 및 숙주 조절로 인해 JE의 발생빈도가 급격히 줄었으며, 특히 최근 10년간 9세이하의 소아에서는 보고된 예가 없다. 따라서 소아에서 발생한 뇌염의 원인으로 먼저 고려하지 않는것이 일반적이나 특징적인 MRI 소견과 함께 혈액및 뇌척수액의 일본뇌염바이러스 항체 양성으로 진단된 소아의 JE 1례가 발견되었다. 환자는 발병 당시 생후 9개월로, 발열 및 열성경련을 주소로 내원하였으며 이후 경련 및 의식저하가 지속되고 호흡부전 및 자율신경계 기능이상을 동반한 나쁜 경과를보였으나 스테로이드 및 면역글로불린 치료를 병행하면서 서서히 호전되었다. 이와 같이 특히 접종 이전의 소아에서 특히 특징적인 MRI 이상을 동반한뇌염의 경우 JE를 반드시 감별해야 하며 의심되는경우 예후 향상을 위해 스테로이드 및 면역글로불린등의 치료를 고려할 수 있겠다.
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