[A Case of Clinically Mild Encephalitis/encephalopathy with a Reversible Splenial Lesion due to Dengue Fever]

MERS associated with bacterial translocation in a pediatric patient with congenital portal vein hypoplasia: A case report

A case of mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) in a female child who developed bacterial translocation from a congenital portal vein hypoplasia is reported. The patient was diagnosed as having portal hypertension after examinations and laboratory results showing splenomegaly and thrombocytopenia at the age of 1 year. The patient required three endoscopic variceal ligation (EVL) surgeries before the age of 9 due to development of multiple esophageal varices. After the second and third EVL procedures, she developed septicemia, possibly due to bacterial translocation associated with the administration of general anesthesia. The day after the third EVL, the patient presented with high fever and neurological disturbances (altered consciousness). Magnetic resonance imaging detected abnormal intensities in the corpus callosum ampulla and cerebral white matter, which suggested a diagnosis of MERS type 2. Considering this clinical course, the possible association between bacterial translocation and MERS in a patient with congenital portal vein hypoplasia and portal hypertension is discussed.

Clinically mild encephalitis/encephalopathy with a reversible splenial lesion of corpus callosum in Chinese children

OBJECTIVE

To investigate the characteristics and etiology of mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) in Chinese children.

METHODS

We collected ten pediatric MERS patients from local hospital and enrolled another nineteen patients by reviewing the available literatures. The information of enrolled patients about clinical features, laboratory data, treatment strategies and prognoses were collected for further analysis.

RESULTS

A total of 29 children, the median age of twenty-nine patients was (4.09±3.64) years old. The male-to-female ratio was 1.42:1.0. The major cause of MERS was viral infection. 18 patients had consciousness disturbance which was the most prominent syndrome. 18 patients had transient seizures and only one needed anticonvulsant treatment for long. 9 patients were observed serum sodium levels <135mEq/L. The cells and protein of cerebral spinal fluid (CSF) were increased in 3 patients. In all patients, brain MRI evaluation revealed typical lesion in splenium of the corpus callosum (SCC). 5 patients had additional lesions involving the periventricular white matter or bilateral centrum semiovale diagnosed. 3 patients were treated with antivirus treatment because of virus infection. 7 patients received corticosteroid. 2 patients received intravenous IVIG. As a result, all patients had fully recovered without neurological residual.

CONCLUSIONS

The result of present study suggests that Chinese children with MERS might have favorable prognosis, although there is still no guideline for treatment.