Mild Encephalitis/Encephalopathy with a Reversible Splenial Lesion Associated with Rhinovirus Infection
Makaleler > Tam Makale · 2015
Yazarlar: Kurugol N Zafer, Gokce Sule, Eraslan Cenk, Saz E Ulas, Kizilcan Sirmen, Cogullu M Ozgur
Journal of Vaccines and Immunology, Uluslararası, 2015, cilt 1, ss 036-038
DOI: 10.17352/jvi.000008
Özet
We report a 7-year-old patient with mild encephalopathy with a reversible splenial lesion (MERS) presenting with recurrent delirious behavior, hallucinations and seizures following common cold.Cranial MRI showed high signal intensity in the splenium of the corpus callosum.Rhinovirus was detected in the nasopharyngeal swab by multiplex PCR.Other respiratory viruses were not detected.Microbiologic tests for Epstein-Barr virus, herpes simplex virus, varicella-zoster virus, cytomegalovirus, measles, mumps, rubella and Mycoplasma pneumoniae were also negative.This is the first reported case of MERS associated with rhinovirus infection.history of neurological disorders.She was not on any medication (e.g., antiepileptic).On admission, she was conscious, but suffered from delirious behavior, hallucinations and refused to walk.Her body temperature was elevated, at 38.2 °C.Clinical examination revealed no focal neurologic signs, but signs of upper respiratory tract infection were noted.Routine blood counts and biochemical investigations, including serum sodium level, were normal.Cerebrospinal fluid (CSF) examinations showed normal cell counts, and protein and glucose levels, and CSF cultures were bacteriologically sterile.Polymerase chain reaction (PCR) assays of CSF for herpes simplex virus 1 and 2, influenza virus, adenovirus, enterovirus, cytomegalovirus, human herpesvirus-6, Epstein-Barr virus and varicella zoster virus were all negative.Electroencephalography was normal.Cranial MRI showed a high intensity signal in the splenium of the corpus callosum on T2-weighted and diffusion weighted images (Figure 1A, 1B).A low apparent diffusion coefficient (ADC) was noted in the same area (Figure 1C).Rhinovirus was detected in a nasopharyngeal swab specimen by multiplex PCR.PCR products were detected by automated polyacrylamide gel electrophoresis using Screen Tape multiple detection system.Specimens which were positive for viral nucleic acids have been further studied by using specific DPO primers, FluA ACE Subtyping and RV15 Screening (Seegene, South Korea) kits.Rhinovirus types A and B, four influenza-A virus subtype human H1 (hH1), human H3 (hH3), swine H1 (sH1), avian H5 (aH5)] and 11 other respiratory viruses [Adenovirus, parainfluenza virus (PIV) types 1-4, human bocavirus (HBoV), human metapneumovirus (HMPV), human coronaviruses (HCoV) OC43, 229E/NL63] were investigated with those tests.While multiplex PCR for other respiratory viruses were negative, rhinovirus was positive.Microbiologic tests for Epstein-Barr virus, herpes simplex virus, varicella-zoster virus, cytomegalovirus, measles, mumps, rubella and Mycoplasma pneumoniae were also negative.Empirical treatment with acyclovir and oseltamivir was administered until the result of laboratory investigations for herpes and influenza virus proved to