Meningitis associated with bilateral optic papillitis following Mycoplasma pneumoniae infection

Reversible splenial lesion syndrome associated with acute Mycoplasma pneumoniae-associated encephalitis: A report of four cases and literature review

Reversible splenial lesion syndrome (RESLES) is a rare clinico-radiological syndrome that is defined as reversible lesions that involve the splenium of the corpus callosum (SCC). RESLES has been reported in patients with a broad spectrum of diseases and conditions, including infections, hypoglycemia and poisoning. The present report described four RESLES cases triggered by Mycoplasma pneumoniae (M. pneumoniae) and discussed the associated diagnostic challenges. Four cases of acute M. pneumoniae-associated encephalitis that displayed RESLES were reviewed. The clinical presentations were nonspecific in these patients. However, magnetic resonance imaging (MRI) revealed consistent lesions in the SCC with a hyperintensity in diffusion-weighted imaging (DWI) and hypointensities in T1WI, which disappeared after a variable lapse. Treatment with azithromycin or combined treatment with immunomodulatory agents if necessary led to a good prognosis. The present findings indicated that radiological diagnosis of RESLES should be considered in patients with M. pneumoniae-associated encephalitis. Furthermore, serum Mycoplasma antibody is important for the diagnosis of M. pneumoniae-associated encephalitis.

Infectious optic neuropathies: a clinical update

Different forms of optic neuropathy causing visual impairment of varying severity have been reported in association with a wide variety of infectious agents. Proper clinical diagnosis of any of these infectious conditions is based on epidemiological data, history, systemic symptoms and signs, and the pattern of ocular findings. Diagnosis is confirmed by serologic testing and polymerase chain reaction in selected cases. Treatment of infectious optic neuropathies involves the use of specific anti-infectious drugs and corticosteroids to suppress the associated inflammatory reaction. The visual prognosis is generally good, but persistent severe vision loss with optic atrophy can occur. This review presents optic neuropathies caused by specific viral, bacterial, parasitic, and fungal diseases.

Chronic meningitis with intracranial hypertension and bilateral neuroretinitis following Mycoplasma pneumoniae infection

A previously well 12-year-old boy presented with a 2-week history of headache, nausea, vomiting and left-sided weakness. He subsequently developed meningism, right abducens nerve palsy, persistent papilloedema and reduced visual acuity in association with a bilateral macular star, consistent with neuroretinitis. Cerebrospinal fluid (CSF) examination indicated chronic meningitis and serological testing confirmed recent Mycoplasma pneumoniae infection, although PCR in CSF was negative. He was treated for aseptic meningitis with ceftriaxone, aciclovir, azithromycin and acetazolamide for intracranial hypertension, with gradual improvement in clinical condition and visual acuity over several weeks. This is the first report of M. pneumoniae chronic meningitis further complicated with bilateral neuroretinitis and intracranial hypertension. Evidence of central nervous system inflammation in the absence of direct infection suggests an immune-mediated pathophysiology. Although the use of macrolides with antibiotic and immunomodulatory activity might be beneficial, it was not possible to ascertain whether it influenced clinical recovery in this case.