Abstract
49 Year old male police officer, presented with acute onset fever, headache, arthralgia, ataxia, dysar- thria, opthalmoplegia, and diplopia, on a background of a 3 day skin erythematous skin rash, which was previously treated as SWEET syndrome. Physical examination further showed cerebellar syndrome, with no pyramidal signs. Blood tests showed raised inflammatory markers. Patient was initially treated for meningoencephalitis, with no change in symptoms after antibiotics and antivirals were administered. MRI revealed hyper intensity at the right pons and cerebellar peduncles, raising concerns of subacute infarct or demyelination. Lumbar puncture showed high protein of 1.15 mg/dL, and no other findings. However, when PCR was performed on the cerebrospinal fluid, mycoplasma pneumoniae was successfully isolated. IV prednisolone 1g was initially trialled, with no obvious therapeutic response after 5 days. As antibiotics and steroids had proved ineffective, decision was made to trial IV-IG. Two courses of IV-IG were trialled on suspicion of mycoplasma auto-immune mediated encephalitis, and symptoms subsequently resolved after 5 days. MRI was repeated after neurorehabilitation, and the hyper intensity found on the previous MRI had resolved completely. (Full Case Report Available on Request)d.mosh666@yahoo.com
Published Version
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