Abstract
BackgroundClinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a clinico-radiological syndrome characterized by transient mild symptoms of encephalopathy and a reversible lesion in the splenium of the corpus callosum on magnetic resonance imaging (MRI). It is often triggered by infection. The common pathogens of MERS are viruses, especially influenza virus. However, Mycoplasma pneumoniae (M.pneumoniae) are relatively rare pathogens for MERS.Case presentationHere we report two paediatric cases of M.pneumoniae infection-induced MERS. The diagnosis of M.pneumoniae infection was established based on polymerase chain reaction (PCR) and specific serum antibodies (IgM). Both of the two patients presented with mild encephalopathy manifestations and recovered completely within a few days. The initial MRI showed a lesion in the central portion of the splenium of the corpus callosum, which completely resolved on the seventh and eighth day after admission for case 1 and case 2. Lumbar puncture was performed in both patients, which revealed no pleocytosis. In case 1, the patient had hyponatremia, peripheral facial nerve paralysis, and rash. To the best of our knowledge, it is the first MERS case associated with peripheral nerve damage. In case 2, interleukin-6(IL-6) was moderately increased in the cerebrospinal fluid (CSF). It suggested that IL-6 may play a role in the pathogenesis of M.pneumoniae-induced MERS.ConclusionOur study enriches the available information on the pathogens of MERS and provides valuable data for better understanding of this syndrome.
Highlights
Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a clinico-radiological syndrome characterized by transient mild symptoms of encephalopathy and a reversible lesion in the splenium of the corpus callosum on magnetic resonance imaging (MRI)
Our study enriches the available information on the pathogens of mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) and provides valuable data for better understanding of this syndrome
Clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a clinico-radiological syndrome, which was first reported by Tada et al in 2004 [1] and further enriched by Takanashi et al [2]
Summary
Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a clinico-radiological syndrome, which was first reported by Tada et al in 2004 [1] and further enriched by Takanashi et al [2]. Specific serum M. pneumoniae antibodies (IgM) were positive at a titre of 1.71 on the sixth day of the disease (ELISA, normal value:< 1.1). Cranial MRI showed a focal high-signal lesion in the splenium of the corpus callosum on diffusion-weighted and T2-weighted images on the day of admission (Fig. 1a, b). The patient showed improvement in mouth drooping on the right side, incomplete eyelid closure, and stabilization of the rash. Cranial MRI showed a focal high-signal lesion in the splenium of the corpus callosum on T2-weighted and fluidattenuated inversion recovery (FLAIR) images on the day of admission (Fig. 2a, b). The patient was discharged with excellent mental status, no obvious cough, normal EEG findings, and no abnormal MRI signals in the corpus callosum (Fig. 2c, d)
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