Mild Encephalitis/encephalopathy With A Reversible Splenial Lesion Research Articles

Neuroimaging in acute infection-triggered encephalopathy syndromes.

Acute encephalopathy associated with infectious diseases occurs frequently in Japanese children (400-700 children/year) and is the most common in infants aged 0-3 years. Acute encephalopathy is classified into several clinicoradiological syndromes; acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) is the most common subtype, followed by clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) and acute necrotizing encephalopathy (ANE). Neuroimaging, especially magnetic resonance imaging (MRI), is useful for the diagnosis, assessment of treatment efficacy, and evaluation of the pathophysiology of encephalopathy syndromes. MRI findings essential for diagnosis include delayed subcortical reduced diffusion (bright tree appearance) for AESD, reversible splenial lesions with homogeneously reduced diffusion for MERS, and symmetric hemorrhagic thalamic lesions for ANE. We reviewed several MRI techniques that have been applied in recent years, including diffusion-weighted imaging for the characterization of cerebral edema, arterial spin labeling for evaluating cerebral perfusion, and magnetic resonance spectroscopy for evaluating metabolic abnormality.

Japanese Spotted Fever Associated with Mild Encephalitis/Encephalopathy with a Reversible Splenial Lesion.

A 58-year-old woman had disseminated intravascular coagulation (DIC) and septic shock caused by Japanese spotted fever (JSF). Following treatment with minocycline, her general condition gradually improved; however, her disorientation persisted. Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) type II was diagnosed based on brain magnetic resonance imaging (MRI) showing a hyperintense area in the splenium of the corpus callosum and bilateral cerebral white matter on diffusion-weighted imaging. Thereafter, her consciousness gradually improved, but she continued to experience difficulty concentrating and attention deficits. MERS type II may take longer to improve than type I, and long-term follow-up is required.

A Case of COVID-Related MERS (Clinically Mild Encephalitis/Encephalopathy with a Reversible Splenial Lesion) with a Typical Imaging Course and Hyponatremia in Adults—A Case Report and Literature Review

Clinically mild encephalitis/encephalopathy with reversible splenial lesions (MERS) is a mild form of encephalitis/encephalopathy that appears in association with various conditions, including infection. COVID-19 is also known to cause MERS. MERS more commonly occurs in children, and adult cases are relatively rare. Typical head MRI findings include a round lesion in the mid-layer of the corpus callosum with a high signal intensity on diffusion-weighted images. Most improve within a week. Although the exact mechanism by which the cerebral corpus callosum is affected is still unknown, several hypotheses have been proposed, including the involvement of electrolyte abnormalities (e.g., hyponatremia) and inflammatory cytokines (e.g., IL-6). In this report, we describe the first case of COVID-associated MERS with a typical imaging course and hyponatremia, with a review of the relevant literature. When psychiatric symptoms and the disturbance of consciousness appear in COVID patients, MERS should be considered in addition to delirium due to fever and hypoxia.

ODP285 A Case of Encephalitis and Adrenal Insufficiency in a Patient With Panhypopituitarism After COVID-19 Vaccination

Abstract Background Since COVID-19 vaccination was introduced, various adverse effects have been linked to the vaccines. In patients with hypopituitarism, adrenal insufficiency due to the side reactions including fever of COVID-19 vaccination is concerned. Clinical Case A 33-year woman was on medical therapy including hydrocortisone (HC) for panhypopituitarism arising from surgical treatment of a pituitary adenoma in 2006. She received a COVID-19 vaccination on day X-3. On day X-2, she developed fever in the morning and became unconscious in the evening. She was brought to our hospital by her family at night on day X. She had fever of 40.5°C, low blood pressure, and Glasgow Coma Scale (GCS) of 11. Her neck was supple and she had no quadriplegia. A COVID-19 PCR test was negative. Blood tests showed elevated white blood cell count (8900/μL; reference range: 3300–8600/µL) and C-reactive protein (138.3 mg/l; reference range: 0-1.44 mg/l). Blood glucose (81 mg/dL), ACTH (<3. 00 pg/mL; reference range: 7.2–63.3 pg/mL), and cortisol (1.9 μg/dL; reference range: 2.9–19.4 µg/dL) were low. Serum electrolytes were normal. A computed tomography scan showed no abnormality. Adrenal insufficiency was suspected, and she received HC intravenously. Her blood glucose and blood pressure increased, but her disorientation persisted. Lumbar puncture with cerebrospinal fluid (CSF) examination revealed slightly elevated cell counts (8 μ/L; reference range ≤4 μ/L) with average protein and glucose levels. Magnetic resonance imaging (MRI) of the brain revealed abnormal hyperintensity in the splenium of the corpus callosum on diffusion-weighted images and decreased apparent diffusion coefficient in the lesion, suggesting clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS). During her hospital stay, she received a 7-day course of meropenem and acyclovir for suspected meningoencephalitis. Her consciousness disturbance improved to GCS of 15 on day X+1 and her fever decreased on day X+2. HSV and VZV PCR tests were negative on CSF examination, and antibiotics and antivirals were discontinued on day X+7. On day X+8, brain MRI showed complete resolution of the corpus callosum lesion. She discharged on day X+18 without any neurological sequelae. Conclusions For most vaccines, the incidence rates of encephalitis are low at 0.1–0.2 per 100,000 vaccinated individuals (1). The present patient developed fever and adrenal insufficiency after COVID-19 vaccination, and her prolonged disturbance of consciousness after HC administration led to the diagnosis of MERS. MERS should be considered in patients with adrenocortical insufficiency who show delayed recovery from unconsciousness with HC administration after COVID-19 vaccination. Reference: (1) Huynh W, Cordato DJ, Kehdi E, Masters LT, Dedousis C. Post-vaccination encephalomyelitis: literature review and illustrative case. J Clin Neurosci. 2008 Dec;15(12): 1315-22. Presentation: No date and time listed

Clinically mild encephalitis/encephalopathy with a reversible splenial lesion of the corpus callosum in childhood: a single-center experience.

Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a rare clinicoradiological syndrome that typically presents with central nervous system symptoms such as loss of consciousness, seizure, headache, and ophthalmoparesis. Here, we highlight the characteristics of this syndrome together with the clinical and MRI findings of 6 pediatric patients with MERS. Between January 2017 and October 2020, 6 patients with MERS (3 boys and 3 girls) presented to our center. The mean age was 122 ± 54.6 (min-max: 44-180) months. None of the patients had a chronic disease. In our study, infectious agents were detected in 4 patients (66.6%), while noninfectious causes (one seizure and the other hyponatremia) were detected in two patients. All of our cases were discharged without any sequelae after an average of 12.1 ± 7 (min-max: 4-20) days of hospitalization. In 1 patient (case 6), control MRI could not be performed, and the radiological recovery of our other patients was shown to be between 14 days and 2 months. MERS is an acute encephalopathy with good prognosis and should be considered by neurologists in differential diagnosis due to its variable clinical presentation and specific MRI findings.

Mild Encephalitis/Encephalopathy With a Reversible Splenial Lesion (MERS) Associated With HHV-7 in a Immunocompetent Adult, A Case Report and Literature Review

Mild Encephalitis/Encephalopathy With a Reversible Splenial Lesion (MERS) Associated With HHV-7 in a Immunocompetent Adult, A Case Report and Literature Review

A cohort study of mild encephalitis/encephalopathy with a reversible splenial lesion in children.

PurposeTo investigate the clinical features, imaging features, and prognosis of mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) in childrenMethodsThe clinical and imaging data of a cohort of 28 children diagnosed as MERS from January 2019 to October 2020 were retrospectively analyzedResultsOf the 28 patients, 17 were males and 11 were females. The onset age ranged from 8 months to 12 years old, with an average age of 4 years and 2 months. All children developed normally before onset, and three of them had a history of febrile convulsion. More than half of the patients (62.9%) had preceding infections of gastrointestinal tract. All the cases developed seizures, and most (71.4%) had more than one time. Other neurological symptoms included dizziness/headache, consciousness disorder, limb weakness, blurred vision, and dysarthria. Cranial magnetic resonance imaging (MRI) showed lesions in the splenium of the corpus callosum in all, extending to other areas of the corpus callosum, bilateral semi‐ovoid center, and adjacent periventricular in two cases. The clinical symptoms were relieved after steroids, intravenous immunogloblin, and symptomatic treatment, without abnormal neurodevelopment during the followed‐up (2 months–2 years). Complete resolution of the lesions was observed 8–60 days after the initial MRI examinationsConclusionMERS in children is related to prodromal infection mostly, with a wide spectrum of neurologic symptoms, characteristic MRI manifestations, and good prognosis.

Increased cytokines/chemokines and hyponatremia as a possible cause of clinically mild encephalitis/encephalopathy with a reversible splenial lesion associated with acute focal bacterial nephritis

ObjectiveClinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS), the second most common encephalopathy syndrome in Japan, is most often associated with viral infection. Bacterial MERS has been rarely reported but is mostly associated with acute focal bacterial nephritis (AFBN) for an unknown reason. We examined cytokines and chemokines in four MERS patients with AFBN to determine if they play an important role in the pathogenesis. MethodsWe examined the clinical charts and MRI results in four MERS patients with AFBN, and measured 10 cytokines and chemokines in serum and cerebrospinal fluid in the acute phase. These were analyzed using the Mann-Whitney U test, compared with the control group (cases with a non-inflammatory neurological disease). Longitudinal changes in the serum cytokine and chemokine levels were evaluated in two patients. ResultsHyponatremia was observed in all four patients with MERS associated with AFBN (128–134 mEq/L). CSF analysis revealed increased cytokines/chemokines associated with Th1 (CXCL10, TNF-α, IFN-γ), T reg (IL-10), Th17 (IL-6), and neutrophil (IL-8 and CXCL1). In serum, upregulation was observed in those associated with Th1 (CXCL10, TNF-α, IFN-γ), Th17 (IL-6), and inflammasome (IL-1ß). The increased serum cytokines/chemokines in the acute stage normalized within 2 weeks in patients 1 and 2, so examined, in accordance with their clinical improvement. ConclusionIncreased cytokines/chemokines and hyponatremia may be factors that explain why AFBN is likely to cause MERS.

Mild Encephalopathy with Reversible Splenial Lesion(MERS)

Mild encephalitis/encephalopathy with a reversible splenial lesion(MERS)is a clinically and radiologically benign condition that has been described within the past two decades. MRI findings include isolated symmetrical ovoid lesions of the splenium with a high-intensity signal on DWI and decreased apparent diffusion coefficient. These findings have been associated with viral infections, epilepsy, antiepileptic drug usage, and metabolic disturbances, among others. These conditions may present with severe clinical features, such as consciousness disturbance or cytokine storm; however, patients usually recover completely with optimal treatment. Some pathological conditions with splenic lesions, such as Marchiafava-Bignami disease, may be irreversible. Therefore, diseases with splenic lesions require careful attention.

Presumed Encephalitis With a Reversible Splenial Lesion

Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a clinicoradiologic syndrome which consists of a transient lesion usually located in the midline of the corpus callosum that shows restricted diffusion. The exact pathophysiology of this entity is still unknown. We present the case of a 9-year-old boy with a history of 3 days of headache and vomiting associated with an episode of syncope and mild hyponatremia. Magnetic resonance imaging (MRI) findings included a focal lesion with well-defined margins on the splenium of the corpus callosum with hyperintensity on T2 and diffusion-weighted images. The patient underwent full recovery, and a follow-up MRI 5 months later showed no signs of the initial lesion. In conclusion, MERS is part of the spectrum of cytotoxic lesions of the corpus callosum, which must be recognized as secondary to a several causes, to avoid an erroneous diagnosis and treatment of the patient. It should be emphasized the importance of continuing research on this type of process to clarify its pathophysiology as well as the long-term effects. Int J Clin Pediatr. 2021;10(1):24-27 doi: https://doi.org/10.14740/ijcp405

Transient blindness associated with mild encephalitis/encephalopathy with a reversible splenial lesion (MERS): a case report and review of literature

BackgroundMild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a clinical-radiological syndrome that can be related to infectious and non-infectious conditions. The most prominent neurological symptoms are disturbance of consciousness, abnormal speech, delirious behavior, seizures, muscle weakness, ophthalmoplegia, facial nerve paralysis and headache. Here we report the case of a child with MERS presenting with the unusual symptom of bilateral transient blindness.Case presentationA 4-year-old female patient, with a history of fever, abdominal pain, loss of appetite and cough lasted for a few days, experienced 3 episodes of transient bilateral loss of vision with difficulty in walking. Her physical examination showed absence of focal neurological and meningeal irritation signs, although responsiveness was slightly impaired. The ophthalmologic evaluation, including a fundus oculi examination, was negative.The electroencephalogram showed slow activity in the temporo-occipital regions, more evident in the right hemisphere. A lumbar puncture was performed and cerebrospinal fluid analysis revealed normal glycorrhachia, cell counts, protein levels and IgG index.Magnetic resonance imaging of the brain showed a signal alteration in the splenium of the corpus callosum, without contrast enhancement. This finding was suggestive of a reversible cytotoxic lesion. Empiric antiviral treatment with acyclovir and intravenous dexamethasone was initiated. Polymerase chain reaction search for neurotropic viral nucleic acid sequences in the cerebrospinal fluid was negative, while a low number of HHV-6 DNA copies was detected in the blood.Electroencephalograms were repeated in the following days, showing a progressive normalization of the pattern. The child was discharged without symptoms after 10 days of treatment with oral corticosteroids. After 40 days, brain magnetic resonance imaging showed a complete normalization of the signal alteration in the splenium of the corpus callosum.ConclusionTransient blindness was reported as an initial symptom of MERS in a few children. To date, there is no evidence of effective treatment methods. Nonetheless, MERS diagnosis provides pediatricians with valuable prognostic information in order to reassure patients and their families about the good outcome of this disease.

Mild encephalitis/encephalopathy with reversible splenial lesion (MERS) in twin sisters with two CD36 frameshift mutations.

Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a clinical radiological syndrome with good prognosis that affects mainly children or young adults. We describe two cases of MERS, associated with echovirus 6 and influenza A infection, in two twin sisters, at the age of 4years. Genetic analysis was performed; next exome sequencing was performed on twins to disclose the eventual causative gene. Two different frameshift mutations in the CD36 gene [NM_000072] were found in both twins and confirmed by Sanger sequencing. To best of our knowledge, we report an association between CD36 mutation and MERS. We think that this relation between CD36 and inflammation has had a crucial role in the same callosal alteration during viral disease in the twin sister with the same gene mutation.

Epidemiological changes of acute encephalopathy in Japan based on national surveillance for 2014–2017

BackgroundWe previously reported the nationwide, epidemiological data of acute encephalopathy in Japan during 2007–2010. Here we conducted the second national survey of acute encephalopathy during 2014–2017, and compared the results between the two studies to elucidate the trends in the seven years’ interval as well as the influence of changes in pediatric viral infections and guidelines for acute encephalopathy in Japan. MethodsThe Research Committee on Acute Encephalopathy supported by the Japanese Government sent a questionnaire to 507 hospitals throughout Japan, and collected the responses by mail. ResultsA total of 1115 cases from 267 hospitals reportedly had acute encephalopathy during April 2014–June 2017. In this study, the age at onset was younger, the ratios of recently established syndromes, such as acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) and clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS), were higher, and the ratio of influenza-associated encephalopathy was lower, than in the previous study. The age at onset of influenza-associated encephalopathy was lower, and that of HHV-6/7-associated encephalopathy higher, compared to the first survey. The outcomes of entire acute encephalopathy remained unchanged. ConclusionSome of these changes reflected the recent trends of viral infectious diseases including 2009 influenza pandemic, and others the standardization of the diagnosis of acute encephalopathy in Japan.

Acute Focal Bacterial Nephritis Associated With Reversible Splenial Corpus Callosum Lesion

Acute focal bacterial nephritis (AFBN) is a localized bacterial infection of the kidney, which presents as an inflammatory mass without formation of a frank abscess. Rare cases of AFBN are accompanied by neurological symptoms such as meningeal irritation, unconsciousness, and seizures. Clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is characterized by transient high signal intensity splenial lesions on diffusion-weighted magnetic resonance imaging. MERS can be divided into two types: type 1 with an isolated splenium of the corpus callosum and type 2 with extensive white matter and/or entire callosal lesions. We experienced three rare cases of pediatric AFBN associated with neurological symptoms, including unconsciousness and reversible splenial corpus callosum lesion. The first case was an 8-year-old girl who had neurological symptoms, including unconsciousness, and AFBN was associated with MERS type 2. The second (5-year-old boy) and third (5-year-old girl) cases had neurological symptoms, including unconsciousness and AFBN with MERS type 1. Two of the three cases had AFBN caused by Escherichia coli . All three cases showed high levels of urinary beta 2 -microglobulin (B2MG). AFBN should be suspected in children with fever, rapid clinical deterioration, neurological symptoms including unconsciousness, and high urinary B2MG level. We recommend that abdominal enhanced computed tomography should be performed for the diagnosis of AFBN. Int J Clin Pediatr. 2020;9(3):82-86 doi: https://doi.org/10.14740/ijcp395

Statistical Analysis of the Apparent Diffusion Coefficient in Patients with Clinically Mild Encephalitis/Encephalopathy with a Reversible Splenial Lesion Indicates That the Pathology Extends Well beyond the Visible Lesions.

Purpose:To investigate whether the genu of the corpus callosum is involved in patients with clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) type I.Methods:Twenty-three cases of clinically confirmed MERS I were analyzed retrospectively, and MRI features of the lesion were observed. The apparent diffusion coefficient (ADC) values of the same region of interests in lesions at the splenium and genu of the corpus callosum were measured before and after treatment (i.e., four groups), and the average ADC values were calculated. Paired t-tests were used to compare the ADC values of lesions in the splenium and genu before and after treatment. Independent sample t-tests were used to compare the values in the splenium and genu after treatment.Results:The mean ADC values of the splenium before and after treatment were 0.448 ± 0.124 and 0.790 ± 0.070 × 10−3 mm2/s, respectively, showing significant difference (P < 0.01). The mean ADC values in the genu before and after treatment were 0.783 ± 0.067 and 0.829 ± 0.070 × 10−3 mm2/s, respectively, also showing significant difference (P < 0.01). There was no significant difference in the ADC values between the splenium and genu after treatment (P > 0.05).Conclusion:The genu showed a slight restriction in diffusion in the acute stage of type I MERS. After treatment, this diffusion restriction diminished as it typically does in the splenium. Our results indicate that the pathology in MERS extends well beyond the visible lesions.

Clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) in a child with ataxia and diplopia

We report the case of a 15-year-old boy with clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS). He presented with diplopia and ataxia and his cerebrospinal fluid showed mild pleocytosis and elevated protein. MRI demonstrated a reversible splenial lesion in the corpus callosum. He did not receive any treatment and recovered quickly within two weeks. Results of neurological examination after 3 months were completely normal. MERS is relatively unknown in Europe. The majority of patients are reported in East Asia. This post-infectious encephalitis/encephalopathy arises soon after the onset of symptoms. The prognosis is excellent and most patients recover completely without neurological sequelae. MRI typically shows a reversible splenial lesion with diffusion restriction and without contrast enhancement, sometimes with adjacent symmetrical lesions extending into the subcortical white matter. The pathogenesis is still unknown. Recognition of the condition and its clinic-radiological discrimination from acute disseminated encephalomyelitis may prevent unnecessary treatment.

Mild encephalitis/encephalopathy with a reversible splenial lesion due to Plasmodium falciparum malaria: a case report

BackgroundNeurological complications from malaria cause significant morbidity and mortality. Severe cerebral malaria occurs as a result of intense sequestration of infected erythrocytes in the cerebral capillaries. However, the pathology of the reversible neurological symptoms remains unclear. We report the case of a patient with malaria who also had mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) causing transient neurological symptoms.Case presentationA 55-year-old Japanese man was admitted to our hospital with acute fever upon returning from Nigeria. Blood smears and PCR analysis revealed ring forms in the erythrocytes, indicative of Plasmodium falciparum infection. He presented with dysarthria, expressive aphasia, and truncal ataxia, all of which were suggestive of cerebellar ataxia. He had no other signs or symptoms of severe malaria. Artemether/lumefantrine was started on the first day of illness. Although the parasites were undetectable on day 3 of illness, his neurological symptoms persisted. Brain magnetic resonance imaging (MRI) demonstrated a high-signal lesion in the splenium of the corpus callosum on diffusion-weighted images along with a decreased apparent diffusion coefficient. The neurological symptoms gradually improved by day 12. Brain MRI on day 16 showed complete regression of the splenic lesion. Therefore, the patient was diagnosed with MERS due to malaria.ConclusionsMERS often causes transient headaches, seizures, and/or impaired consciousness. The symptoms are compatible with the reversible symptoms of cerebral malaria.

Clinical and imaging features of mild encephalitis/encephalopathy with a reversible splenial lesion in children with mycoplasmmapneumonia infection

Objective To investigate the clinical and imaging features of mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) in children with mycoplasmmapneumonia infection. Methods The clinical data of 15 children with MERS diagnosed in our hospital were analyzed retrospectively. Results Among the 15 cases, there were 5 males and 10 females. The onset age ranged from 2 years old to 11 years old. All the 15 cases were onset of acute infection. 8 cases were onset of vomiting, diarrhea and other gastrointestinal symptoms. 2 cases were onset of respiratory tract infection such as cough. 8 cases were accompanied by fever. 15 cases were accompanied by convulsions. 2 cases were onset of consciousness disturbance. All 15 children underwent lumbar puncture and routine cerebrospinal fluid tests were in normal range. Electroencephalogram examination was abnormal in 13 children, showing slow activity in each lead. The cranial MRI examination of the onset of 4-6 d suggested that the lesions of the corpus callosum were characterized by high signal intensity of DWI sequence. Etiological examination of 15 children showed mycoplasma pneumoniae (MP) -IgM or -Ab positive. In 10 children, the MRI of the corpus callosum was completely restored to normal after 7-12 d. 15 children were treated with anti-infection and azithromycin orally, but not with propofol or hormone. They were discharged after 4-14 days of hospitalization. All 10 children were reexamined with MRI at 7-12 days intervals. Conclusions Minor encephalitis/encephalopathy associated with reversible corpus callosum pressure in children with mycoplasma pneumoniae infection is characterized by mild encephalitis or encephalopathy. The imaging of the corpus callosum is reversible and has a good prognosis. Key words: Pneumonia, mycoplasma; Brain edema; Corpus callosum; Encephalitis; Diagnostic imaging; Child

Mild encephalitis/encephalopathy in children with a reversible splenial lesion

ObjectiveTo investigate the imaging features of a reversible lesion in the splenium of corpus callosum related to encephalitis/encephalopathy in children. MethodsA retrospective analysis was performed on the MRI findings of 84 children suffering from mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) during different infection processes, and the imaging characteristics of the lesion on diffusion weighted image (DWI) were analyzed. ResultsIn the 84 children with MERS, 42 children had upper respiratory tract infection, 33 children had enteritis, 9 children had upper respiratory infection accompanied by enteritis. Among them, 76 cases were of type I, with round or oval lesions in the splenium of corpus callosum, the other 8 cases were of type II, with lesions not only in the splenium of the corpus callosum, but also in the genu of the corpus callosum and in the periventricular white matter. The splenial lesions exhibited high-intensity on the diffusion-weight imaging with low ADC value on the ADC map. The abnormal signal disappeared and normalized in 3–15 days. ConclusionThere are three types of common infection could cause mild encephalitis/encephalopathy with a reversible splenial lesion in children. Reduced diffusion in the splenium of the corpus callosum on DWI proved to be a specific finding that could be used to guide clinical treatment.

MERS associated with bacterial translocation in a pediatric patient with congenital portal vein hypoplasia: A case report.

A case of mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) in a female child who developed bacterial translocation from a congenital portal vein hypoplasia is reported. The patient was diagnosed as having portal hypertension after examinations and laboratory results showing splenomegaly and thrombocytopenia at the age of 1 year. The patient required three endoscopic variceal ligation (EVL) surgeries before the age of 9 due to development of multiple esophageal varices. After the second and third EVL procedures, she developed septicemia, possibly due to bacterial translocation associated with the administration of general anesthesia. The day after the third EVL, the patient presented with high fever and neurological disturbances (altered consciousness). Magnetic resonance imaging detected abnormal intensities in the corpus callosum ampulla and cerebral white matter, which suggested a diagnosis of MERS type 2. Considering this clinical course, the possible association between bacterial translocation and MERS in a patient with congenital portal vein hypoplasia and portal hypertension is discussed.