Respiratory syncytial (RS) virus infection is a causative agent of respiratory tract infection that affects most infants by the age of 2 years. Neurological sequelae, however, are rarely seen with RS virus infection. We reported here a healthy 3-year-old boy with acute encephalopathy who developed the most severe neurological sequelae triggered by RS virus infection.
Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is often associated with ovarian teratomas in young women. However, children are less likely to develop this condition. We herein report a very rare case of anti-NMDAR encephalitis and an ovarian teratoma in a young girl. A previously healthy 9-year-old girl presented with convulsions and unconsciousness. Her cerebral spinal fluid was positive for anti-NMDAR antibody. She underwent immunotherapy, and although her clinical course improved, she did not fully recover. A right ovarian teratoma was then found and removed, and she became negative for anti-NMDAR antibody. She exhibited almost full recovery and no relapse. Tumor resection is recommended in the treatment of anti-NMDAR encephalitis. A tumor search should be actively carried out in patients aged < 12 years.
The patient was a 3-year-old boy. He was admitted to our hospital because of unconsciousness, ataxic gait, dysarthria, and a cut wound on his left finger. A brain computed tomography scan on admission showed no abnormal findings. Blood tests showed hypoglycemia and elevated ketone levels. Blood glucose levels were normalized by the infusion treatment; however, he still had ataxic gait and dysarthria. Through interviews with the medical social worker and the family physician, we found that his mother was on medication for psychiatric illness. A urine drug test kit (Triage ® DOA) detected benzodiazepine. Based on this result, he was diagnosed with acute drug intoxication. If there is a family history of psychiatric illness, a urine drug test kit should be used for the diagnosis of drug intoxication as a differential for unexplained unconsciousness.
Human parechoviruses belong to the Picornaviridae family and are classified into 17 genotypes. Recently, it has been reported that human parechovirus genotype 3 is an important cause of severe infections, including sepsis-like illness and encephalitis, especially in newborns and infants younger than 3 months. There are also reports that human parechovirus genotype 3 infections with central nervous system symptoms lead to high rates of neurological sequelae and death. Here, we report a case of a previously healthy 1-month-old girl who developed encephalitis related to human parechovirus genotype 3 and had a favorable outcome. The patient presented septicemic symptoms, including fever, tachycardia, tachypnea with retractions and seizures without an elevated inflammatory response. She lacked cerebrospinal fluid pleocytosis but had hypercytokinemia. Brain magnetic resonance imaging and electroencephalography showed abnormal findings. Together, these findings strongly suggested acute encephalopathy. She underwent emergency intubation for respiratory failure and mechanical ventilation was started. Intravenous phenobarbital injection was performed to prevent convulsion. She was treated using intravenous immunoglobulin with methylprednisolone pulse therapy. As of 2 years after discharge, her growth development is equivalent to her age and she has had no clinical epileptic seizures. In this case, human parechovirus genotype 3 was detected from pharyngeal swabs, stool, cerebrospinal fluid and blood by polymerase chain reaction assay. The patient was diagnosed definitively with encephalitis related to human parechovirus genotype 3. The symptoms that we observed should be considered for the differential diagnosis of human parechovirus infection. When a patient is suspected of having encephalitis related to human parechovirus, treatment including intravenous immunoglobulin and corticosteroid must be started as soon as possible to prevent neurodevelopmental sequelae.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.