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KMID : 0391520160240040266
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Journal of the Korean Child Neurology Society
2016 Volume.24 No. 4 p.266 ~ p.271
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A Girl of Unusual Diffuse White Matter and Basal Ganglia Lesions Following Streptococcus Pneumoniae Meningoencephalitis
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Lee Hoon-Sang
Kim Kyung-Min
Nam Sang-Ook
Kim Young-Mi
Yeon Gyu-Min
Lee Yun-Jin
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Abstract
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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.
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KEYWORD
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Streptococcus pneumoniae, Meningoencephalitis, White matter Infant
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