Mild encephalopathy with a reversible splenial lesion in a girl with acute pyelonephritis
We report the case of a 12-year-old girl who had mild encephalopathy with a reversible splenial lesion (MERS) associated with acutepyelonephritis caused by Escherichia coli. The patient was admitted with a high fever, and she was diagnosed with acute pyelonephritis based on pyuria and the results of...
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doaj-e17ba1f6ccfc45f9bd9d87a6d1295ee22020-11-24T21:04:51ZengKorean Pediatric SocietyKorean Journal of Pediatrics1738-10612092-72582018-02-01612646710.3345/kjp.2018.61.2.6420125550705Mild encephalopathy with a reversible splenial lesion in a girl with acute pyelonephritisJung Sook Yeom0Chung Mo Koo1Ji Sook Park2Ji-Hyun Seo3Eun Sil Park4Jae-Young Lim5Hyang-Ok Woo6Hee-Shang Youn7Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea.Department of Pediatrics, Changwon Gyeongsang National University Hospital, Changwon, Korea.Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea.Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea.Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea.Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea.Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea.Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea.We report the case of a 12-year-old girl who had mild encephalopathy with a reversible splenial lesion (MERS) associated with acutepyelonephritis caused by Escherichia coli. The patient was admitted with a high fever, and she was diagnosed with acute pyelonephritis based on pyuria and the results of urine culture, which detected cefotaxime-sensitive E. coli. Although intravenous cefotaxime and tobramycin were administered, her fever persisted and her C-reactive protein level increased to 307 mg/L. On day 3 of admission, she demonstrated abnormal neuropsychiatric symptoms, such as delirium, ataxia, and word salad. Magnetic resonance imaging (MRI) of the brain performed on day 4 showed marked hyperintensities in the bilateral corpus callosum and deep white matter on diffusion-weighted images, with corresponding diffusion restriction on apparent diffusion coefficient mapping. No abnormalities or pathogens were detected in the cerebrospinal fluid; however, lipopolysaccharides (LPS, endotoxin) were detected in plasma (41.6 pg/mL), associated with acute neurological deterioration. Her clinical condition gradually improved, and no neurological abnormalities were observed on day 6. Follow-up brain MRI performed 2 weeks later showed near-disappearance of the previously noted hyperintense lesions. In this patient, we first proved endotoxemia in a setting of MERS. The release of LPS following antibiotic administration might be related to the development of MERS in this patient. The possibility of MERS should be considered in patients who present with acute pyelonephritis and demonstrate delirious behavior.http://kjp.or.kr/upload/pdf/kjped-61-64.pdfEncephalopathyCorpus callosumWhite matterPyelonephritis |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Jung Sook Yeom Chung Mo Koo Ji Sook Park Ji-Hyun Seo Eun Sil Park Jae-Young Lim Hyang-Ok Woo Hee-Shang Youn |
spellingShingle |
Jung Sook Yeom Chung Mo Koo Ji Sook Park Ji-Hyun Seo Eun Sil Park Jae-Young Lim Hyang-Ok Woo Hee-Shang Youn Mild encephalopathy with a reversible splenial lesion in a girl with acute pyelonephritis Korean Journal of Pediatrics Encephalopathy Corpus callosum White matter Pyelonephritis |
author_facet |
Jung Sook Yeom Chung Mo Koo Ji Sook Park Ji-Hyun Seo Eun Sil Park Jae-Young Lim Hyang-Ok Woo Hee-Shang Youn |
author_sort |
Jung Sook Yeom |
title |
Mild encephalopathy with a reversible splenial lesion in a girl with acute pyelonephritis |
title_short |
Mild encephalopathy with a reversible splenial lesion in a girl with acute pyelonephritis |
title_full |
Mild encephalopathy with a reversible splenial lesion in a girl with acute pyelonephritis |
title_fullStr |
Mild encephalopathy with a reversible splenial lesion in a girl with acute pyelonephritis |
title_full_unstemmed |
Mild encephalopathy with a reversible splenial lesion in a girl with acute pyelonephritis |
title_sort |
mild encephalopathy with a reversible splenial lesion in a girl with acute pyelonephritis |
publisher |
Korean Pediatric Society |
series |
Korean Journal of Pediatrics |
issn |
1738-1061 2092-7258 |
publishDate |
2018-02-01 |
description |
We report the case of a 12-year-old girl who had mild encephalopathy with a reversible splenial lesion (MERS) associated with acutepyelonephritis caused by Escherichia coli. The patient was admitted with a high fever, and she was diagnosed with acute pyelonephritis based on pyuria and the results of urine culture, which detected cefotaxime-sensitive E. coli. Although intravenous cefotaxime and tobramycin were administered, her fever persisted and her C-reactive protein level increased to 307 mg/L. On day 3 of admission, she demonstrated abnormal neuropsychiatric symptoms, such as delirium, ataxia, and word salad. Magnetic resonance imaging (MRI) of the brain performed on day 4 showed marked hyperintensities in the bilateral corpus callosum and deep white matter on diffusion-weighted images, with corresponding diffusion restriction on apparent diffusion coefficient mapping. No abnormalities or pathogens were detected in the cerebrospinal fluid; however, lipopolysaccharides (LPS, endotoxin) were detected in plasma (41.6 pg/mL), associated with acute neurological deterioration. Her clinical condition gradually improved, and no neurological abnormalities were observed on day 6. Follow-up brain MRI performed 2 weeks later showed near-disappearance of the previously noted hyperintense lesions. In this patient, we first proved endotoxemia in a setting of MERS. The release of LPS following antibiotic administration might be related to the development of MERS in this patient. The possibility of MERS should be considered in patients who present with acute pyelonephritis and demonstrate delirious behavior. |
topic |
Encephalopathy Corpus callosum White matter Pyelonephritis |
url |
http://kjp.or.kr/upload/pdf/kjped-61-64.pdf |
work_keys_str_mv |
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