Acute encephalopathy and tubulointerstitial nephritis associated with Yersinia pseudotuberculosis

Abstract

We report the case of a 28-month-old boy with encephalopathy and acute tubulointerstitial nephritis possibly associated with Yersinia pseudotuberculosis (Yp) infection. He was transferred to our center because of impairment of renal function and altered consciousness. He had fever for 5 days after recurrent vomiting and diarrhea. Computed tomography scan was normal, but electroencephalogram (EEG) analyses showed generalized slow wave patterns. Continuous hemodialysis was undergone and then his renal function was improved, but altered consciousness persisted. Single photon emission computed tomography (SPECT) revealed abnormally low signals at entire field, which suggested that he was suffered from encephalopathy. Phenobarbital administration and post-encephalopathy rehabilitation were started, and he recovered in fully premorbid state with normal EEG and SPECT findings on the 33rd hospital day. Various bacterial cultures were negative, but both Yp antibody and Yp-derived mitogen (YPM) antibody, the antibody of a specific Yp exotoxin, had an extremely high titer. This is the first report of encephalopathy potentially caused by Yp, indicated by the presence of a high Yp and YPM antibody titer.

Yersinia pseudotuberclosis bacteremia with rare complications

“…The cause of the consciousness disorder in this patient might have been an encephalopathy‐like event, because Yp is rarely associated with encephalopathy, 4 and no other causes were observed. Magnetic resonance imaging and EEG reports were normal but were not performed during the consciousness disorder, indicating a limitation of this case report.…”

A Case of Acute Encephalopathy Associated with Acute Focal Bacterial Nephritis

“…Initially, we did not suspect this case to be acute encephalopathy, as acute encephalopathy associated with bacterial infections are not common. However, there are multiple reports of acute encephalopathy with bacterial infection, such as those cased by S.pneumoniae 9 , S.aureus 10,11 , E.faecalis 4, Yersinia pseudotuberculosis 12 . It is important to keep these cases in mind and perform careful follow-up even if an initial diagnosis of complex febrile seizures with bacterial infection is made.…”

Yersinia pseudotuberculosis Infection Complicated with Bacteremia in a 10-Month-Old Boy

“…Based on the CSF examination results, encephalitis was considered to be unlikely the cause of convulsions. Although acute encephalopathy has been reported to occur as a rare complication of Y. pseudotuberculosis infection [ 16 , 17 ], mild encephalopathy cannot be denied because head MRI examination was not performed. However, postconvulsive consciousness was clear, without recurrent convulsions and prolongation of consciousness disorder; thereby, the patient is suspected to have simple febrile seizure only.…”