Acute hæmorrhagic encephalitis associated with acute rheumatism

Abstract

PLATES XLI. AND XLII.) THIS case of acute haemorrhagic encephalitis (for literature see Baker, 1935; Russell, 1937) is of interest because there was a clinical association with acute rheumatism but no evidence of specific rheumatic change in the brain. We know of only one other similar case (Alpers, 1928). Clinical history.S. E., aged 8 years, was admitted on 2nd October 1937 to University College Hospital with the following history. Two days before admission she had complained of malaise, nausea and a pain in the left knee. The following day there was pain in the left wrist and left ankle and she felt cold. On the clay of admission she had slight headache and a sore throat and the joint pains were more severe, especially in the left knee. There was never any symptom indicating involvement of the central nervous system, nor was there a history of vomiting.She had had diphtheria at 4 and measles at 6 years of age, otherwise the past history was uneventful. The father was alive, well and in work. The mother had died six years previously of cancer.The patient was a well developed, rather thin girl, lying very quietly in bed. She appeared to be only moderately ill and complained chiefly of pain in the left knee and to a less extent in the left ankle and left wrist. Temperature 100*5'F., pulse 125, respirations 30. She was flushed and perspiring slightly. The apex beat was forcible and best felt half an inch outside the nipple line. There was a soft systolic murmur at the apex, conducted into the axilla. The left knee was hot, swollen and acutely painful on movement of the joint or even on slight pressure. The left wrist and left ankle were both slightly tender and acutely painful on movement but not swollen. The right knee was slightly painful on movement. There were no abnormal physical signs in the lungs, abdomen or central nervous system. There were no nodules or skin rashes, nor were there any abnormal constituents in the urine.The case was considered t o be a straightforward one of acute articular rheumatism with carditis, and treatment with salicylates was started immediately. The patient was given 20 gr. each of sodium salicylate and She was one of a family of four healthy children.

Brain damage complicating septic shock: acute haemorrhagic leucoencephalitis as a complication of the generalised Shwartzman reaction.

“…Most cases arise in the wake of a banal upper respiratory tract infection but some have been described in association with diseases presumed to be autoallergic-for example, thrombotic thrombocytopenic purpura (Symmers, 1956), ulcerative colitis (Glotzer et al, 1964), acute rheumatism (Dobbs and de Saram, 1938), acute glomerulonephritis (Aldridge, 1956), and asthma and other atopic phenomena (Greenfield, 1950;Moossy et al, 1954;Aronson and Aronson, 1966). Acute 1942), arsphenamine (Russell, 1937), oxyphenarsine (Symmers, 1956), and para-amino salicylic acid (Edge, 1951;Marsh, 1952;Cavanagh, 1953).…”